摘要
目的分析2016—2018年彝族地区剖宫产率和剖宫产指征的变化,研究影响因素并总结合理控制剖宫产率的手段。方法对2016—2018年彝族地区昭觉县人民医院妇产科收治的住院分娩产妇共9898例(剖宫产1122例)进行回顾性分析;统计剖宫产率、剖宫产指征,对剖宫产的影响因素进行单因素及多因素Logistic回归分析。结果(1)2016—2018年彝族地区剖宫产率总体保持在较低水平,2017年剖宫产率为12.69%,明显高于2016年的10.58%,差异有统计学意义(P<0.05);2018年随着医院提倡自然分娩、严格剖宫产指征后,2018年剖宫产率为10.88%,明显低于2017年的12.69%,差异有统计学意义(P<0.05);2016年、2017年、2018年的二次剖宫产率明显高于对应年份的初次剖宫产率,差异均有统计学意义(P<0.05),而二次剖宫产率呈现逐年上升的趋势;(2)2016年剖宫产指征以头盆不称(28.34%)、瘢痕子宫(27.82%)和胎位异常(10.50%)为主,2017年剖宫产指征以瘢痕子宫(40.41%)、头盆不称(16.88%)和胎儿宫内窘迫(11.25%)为主,2018年剖宫产指征以瘢痕子宫(36.29%)、头盆不称(17.7%1)和胎儿宫内窘迫(11.14%)为主;总体剖宫产指征占比前三位是瘢痕子宫(34.85%)、头盆不称(21.03%)和胎儿宫内窘迫(9.93%);胎儿宫内窘迫等因素的占比逐渐增多,头盆不称、羊水过少等因素的占比逐渐减少。(3)对影响因素进行单因素及多因素Logistic回归分析,其中学历(OR=4.948)、职业(OR=0.554)、年龄(OR=1.819)、人均收入(OR=1.085)是剖宫产的相关影响因素(P<0.05)。结论近年来彝族地区剖宫产率相对于国内发达地区水平较低,2018年已经控制在11%以内。剖宫产指征中,应特别注意瘢痕子宫、头盆不称及胎儿宫内窘迫的影响。临床上应支持和保护自然分娩,减少社会心理因素的影响,严格掌握剖宫产指征,最终达到合理控制剖宫产率、提升产科质量的效果。
Objective To analyze the changes of cesarean section rate and indications in Yi nationality areas from 2016 to 2018,to study the influencing factors and summarize the means of reasonable control of cesarean section rate.Methods The data of 9898 cases(1122 cases of cesarean section)of parturients admitted to the Department of Gynecology and Obstetrics,Zhaojue County People's Hospital in the Yi nationality region from 2016 to 2018 were analyzed retrospectively;the rate of cesarean section and indications of cesarean section were counted,and the influencing factors of cesarean section were analyzed by single factor and multi factor logistic regression analysis.Results(1)From 2016 to 2018,the cesarean section rate in the Yi nationality region remained at a low level.In 2017,the cesarean section rate was 12.69%,significantly higher than 10.58%in 2016(P<0.05);in 2018,with the promotion of natural delivery and strict indications of cesarean section,the cesarean section rate in 2018 was 10.88%,significantly lower than 12.69%in 2017(P<0.05);in 2016(6.97%),2017(7.12%)and 2018(7.58%),the second cesarean section rate was significantly higher than the first cesarean section rate in the corresponding year(all P<0.05);however,the second cesarean section rate showed an increasing trend year by year.(2)In 2016,the indication of cesarean section was cephalopelvic disproportion(28.34%),cicatricial uterus(27.82%)and abnormal fetal position(10.50%).The main indications of cesarean section in 2017 were cicatricial uterus(40.41%),cephalopelvic disproportion(16.88%)and fetal intrauterine distress(11.25%).In 2018,the main indications of cesarean section were cicatricial uterus(36.29%),cephalopelvic disproportion(17.7%)and fetal intrauterine distress(11.14%).The top three indications of cesarean section were cicatricial uterus(34.85%),cephalopelvic disproportion(21.03%)and fetus Intrauterine distress(9.93%);fetal intrauterine distress and other factors gradually increased,the proportion of head and basin imbalance,oligohydramnios and other factors gradually decreased.(3)Single factor and multi factor logistic regression analysis were used to analyze the influencing factors,among which education(OR=4.948),occupation(OR=0.554),age(OR=1.819)and per capita income(OR=1.085)were the related factors(all P<0.05).Conclusion In recent years,the cesarean section rate in Yi nationality areas is lower than that in developed areas in China,and it has been controlled within 11%in 2018.In the indication of cesarean section,special attention should be paid to the effects of scarred uterus,disproportion of cephalopelvic and fetal distress.In clinic,we should support and protect natural childbirth,reduce the influence of social and psychological factors,strictly grasp the indications of cesarean section,and ultimately achieve the effect of reasonable control of cesarean section rate and improvement of obstetric quality.
作者
袁华云
陈奎霖
YUAN Hua-yun;CHEN Kui-lin(Department of Gynaecology and Obstetrics,the People's Hospital of Zhaojue County,Zhaojue 616150,Sichuan,CHINA;Sihe Township Health Center of Xichang City,Xichang 615000,Sichuan,CHINA)
出处
《海南医学》
CAS
2020年第3期329-332,共4页
Hainan Medical Journal
关键词
彝族地区
剖宫产率
剖宫产指征
影响因素
变化趋势
干预措施
Yi nationality area
Cesarean section rate
Indications of cesarean section
Influencing factors
Changing trend
Intervention measures
