Experience in managing severe and extremely severe COVID-19 in pregnant women

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论证。在由SARS-CoV-2病毒引起的COVID-19大流行的背景下，病毒性肺炎是冠状病毒感染的主要临床形式，也是孕产妇死亡的一个重要原因。

本研究的目的是评估COVID-19严重与极端严重形式的病程性质、其对怀孕和胎儿的影响以及孕产妇死亡率。

材料与方法。对39例重度与极重度COVID-19患者的病历进行了回顾性评估。患者被分为两组。第一组包括22名冠状病毒感染过程严重且结果良好的孕妇；第二组包括17名孕妇，其中SARS-CoV-2引起的并发症导致了致命的结果。

结果。严重病程患者80%以上为孕妇贫血。最重要的临床和内科不良结果因素是妊娠期糖尿病（p=0.02）、先兆子痫（р=0.05）和缺水（р=0.01）。在死亡的患者中，被诊断为肥胖的人数比其他患者高两倍。两组患者临床表现均以发热、气短、乏力、干咳为主。在实验室检测中，在疾病最严重时死亡的患者白细胞增多，尿素和乳酸脱氢酶水平高于恢复的患者（p=0.05）。两组患者丙氨酸转氨酶和天门冬氨酸转氨酶活性均升高。死亡患者的平均转氨酶值比康复后孕妇高两倍。随着呼吸衰竭增加，两组患者均需要氧支持。绝大多数重症与极端重症患者在妊娠晚期暴露于冠状病毒感染。

结论。在晚期妊娠，COVID-19的严重与极端严重的病程更容易引起不良后果。妊娠期糖尿病、子痫前期和缺水是COVID-19孕妇易发生严重病程和预后不良的主要伴随疾病。冠状病毒感染的严重过程伴随着呼吸急促和发烧，并有明显的肺组织损伤。肝酶活性的显著增加和胎盘功能不全的增加可作为多器官功能衰竭的一种表现，提示预后不良。

作者简介

Aygul I. Gareyeva

S.P. Botkin Clinical Infectious Diseases Hospital

Email: aygul.gareeva.90@mail.ru
ORCID iD: 0000-0001-7403-4594

MD

俄罗斯联邦, Saint Petersburg

Elena V. Mozgovaya

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; Saint Petersburg State University

Email: elmozg@mail.ru
ORCID iD: 0000-0002-6460-6816
SPIN 代码: 5622-5674

MD, Dr. Sci. (Med.)

俄罗斯联邦, 3, Mendeleevskaya Line, Saint Petersburg, 199034; Saint Petersburg

Maria A. Belopolskaya

S.P. Botkin Clinical Infectious Diseases Hospital; Institute of Experimental Medicine

Email: belopolskaya.maria@yahoo.com
ORCID iD: 0000-0002-5107-8831

MD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Alexey S. Kovalchuk

S.P. Botkin Clinical Infectious Diseases Hospital

Email: babai_jo@bk.ru
ORCID iD: 0000-0001-8206-6561

MD

俄罗斯联邦, Saint Petersburg

Alexandr N. Kucheryavenko

S.P. Botkin Clinical Infectious Diseases Hospital

编辑信件的主要联系方式.
Email: botkin.zamakush@zdrav.spb.ru

MD

俄罗斯联邦, Saint Petersburg

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