患产后高血压的急诊室访问和再入院的风险因素
Jenny Y Mei1, Sabrina Alexander1, Hector E Muñoz2
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California (UCLA), Los Angeles, CA, USA.
概括
40岁以上的母亲年龄,慢性高血压,严重的妊娠前,以及在怀孕期间或出院时需要抗高血压药物,显著增加了产后高血压急诊室访问或再入院的风险. 识别这些风险因素可以帮助预防此类事件.
科学领域:
- 产科和妇科 产科和妇科
- 怀孕期间的心血管健康
- 公共卫生和质量改善
背景情况:
- 产后高血压是急诊室 (ED) 访问和再入院的重要原因,影响了孕产妇的发病率.
- 产后高血压的再入院是关键的质量指标,表明不理想的管理和潜在的不良结果.
- 识别风险因素对于制定有针对性的干预措施来减少产后高血压相关的医疗保健利用至关重要.
研究的目的:
- 评估与产后急诊室访问和高血压再入院相关的特定风险因素.
- 为了确定患者的特征和临床因素,预测由于产后高血压需要紧急护理或再住院.
- 为高风险产后患者制定预测模型和有针对性的干预措施提供信息.
主要方法:
- 在2017-2022年期间,对16,162名患有产周高血压的分娩患者进行了回顾性队列研究.
- 纳入标准:年龄≥18岁,诊断为慢性高血压或妊娠高血压障碍,以及在机构的分娩/ED访问.
- 产后高血压患者在42天内进行ED检查或再入院 (EDR) 的患者与常规门诊监测患者的比较.
主要成果:
- 14.9%的患者患有周周高血压,9.1%的患者经历了ED访问或再入院 (EDR).
- 严重的EDR风险因素包括母亲年龄≥40,剖腹产,慢性高血压,具有严重特征的孕前,产后出血和产后IV抗高血压药的使用.
- 多变量分析证实,母亲年龄≥40 (aOR 1.56),PO抗高血压药物在出院时 (aOR 4.05),有严重特征的孕前 (aOR 2.50) 和IV抗高血压药物暴露史 (aOR 9.30) 独立地与EDR相关.
结论:
- 母亲年龄≥40岁,慢性高血压,有严重特征的孕前,以及需要服用抗高血压药物 (IV产后或PO出院时) 是产后高血压EDR的关键预测因素.
- 出院前血压升高也与EDR风险增加有关.
- 识别这些风险因素可以创建预测工具和有针对性的干预措施,以减少产后ED访问和高血压再入院.
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