陈　冰，高玉萍

(福建省泉州市泉港区妇幼保健院妇产科，福建 泉州 362801)



近5年剖宫产指征及剖宫产率的变化分析

陈冰，高玉萍

(福建省泉州市泉港区妇幼保健院妇产科，福建 泉州 362801)

目的分析2011至2015年之间福建省泉州市泉港区妇幼保健院妇产科的剖宫产率及剖宫产指征的变化，分析变化的原因及指导如何进一步有效降低剖宫产率。方法回顾性分析2011至2015之间总分娩例数5 291，总剖宫产1 823例，比较剖宫产率的变化及剖宫产指征的变化。结果2011年至2015年剖宫产率分别为42.02%、42.95%、35.00%、25.43%、26.83%，组间差异无统计学意义(χ2=1.22，P>0.05)，2013年破宫产率较2011年和2012年明显偏低(χ2值分别为4.13、4.53，均P<0.05)，2014年较2011年至2013年水平均明显降低(χ2值分别为4.21、4.77、5.12，均P<0.05)，2015年与2014年组间破宫产率比较无明显差异(χ2=1.02，P>0.05)。至2013年社会因素导致的产程异常和胎儿窘迫比例明显低于2011年水平(χ2值分别为4.21、7.46，均P<0.05)，2014年及2015年社会因素所占比例明显回升，较2013年显著升高(χ2值分别为4.31、4.02，均P<0.05)，社会因素比例总体呈现下降趋势。2015年水平较2011年水平明显偏低(χ2值分别为12.64、5.43、7.32、4.94、5.33、5.01，均P<0.05)，而瘢痕子宫、双胎妊娠、臀位、脐带绕颈、前置胎盘以及其他等非社会因素比例呈现总体显著上升趋势(χ2值分别为6.21、4.67、5.23、4.37、5.83，均P<0.05)。结论近5年来泉州市泉港区妇幼保健院剖宫产率呈现下降趋势，剖宫产指征构成也出现明显的改变，对于之后的剖宫产率的进一步控制做出干预方向的指导。

剖宫产率；剖宫产指征；影响因素；变化

[Abstract]Objective To analyze the changes of cesarean delivery rate and cesarean section indications in Maternal and Child Health Care Hospital of Quangang District from 2011 to 2015 as well as their reasons so as to provide guidance for further effective reduce of cesarean delivery rate. Methods We retrospectively analyzed the clinical data of 5 291 cases of pregnant women including 1 823 cases of cesarean section from 2011 to 2015. Changes of cesarean delivery rate and cesarean section indications were analyzed. Results The cesarean delivery rate was 42.02%, 42.95%, 35.00%, 25.43% and 26.83%, respectively from 2011 to 2015, and there was no significant difference (χ2=1.22,P>0.05). The cesarean delivery rate in 2013 was obviously lower than that in 2011 and 2012 (χ2value was 4.13 and 4.53, respectively, bothP<0.05), and that in 2014 decreased significantly compared to 2011 and 2013 (χ2value was 4.21, 4.77 and 5.12, respectively, allP<0.05). The cesarean delivery rate in 2015 and 2014 was not significantly different (χ2=1.02,P>0.05). The abnormal labor and fetal distress rate caused by social factors in 2013 were significantly lower than in 2011 (χ2value was 4.21 and 7.46, respectively, bothP<0.05). The proportion of social factors in 2014 and 2015 rebounded and was significantly higher than that in 2013 (χ2value was 4.31 and 4.02, respectively, bothP<0.05), and overall proportion of social factors showed a declining trend. And the levels in 2015 were significantly lower than in 2011 (χ2value was 12.64, 5.43, 7.32, 4.94, 5.33 and 5.01, respectively, allP<0.05), while non-social factors such as scar uterus, twin pregnancy, breech, umbilical cord around the neck and others showed a marked increase trend in overall (χ2value was 6.21, 4.67, 5.23, 4.37 and 5.83, respectively, allP<0.05). Conclusion In the last five years, cesarean delivery rate has been reduced year by year, and the indications have changed a lot, which provide guidance for intervention in further control of cesarean delivery rate.

[Key words]cesarean delivery rate；indication for cesarean delivery；influencing factors; change

剖宫产或称剖腹产，是产科领域中的重要手术，已经成为解决难产和某些产科合并症，挽救产妇和围产儿生命的有效手段。然而随着剖宫产技术的提高，我国的剖宫产率一度居高不下，甚至有的医院剖宫产率高达60%以上，且社会因素居首要位置[1]。剖宫产率的不断升高并不降低母儿的分娩风险，相反对母儿的远期健康可能造成不良影响，世界卫生组织(world health organization，WHO)倡导将剖宫产率控制在15%以下[2]。本文就泉州市泉港区妇幼保健院的5年来剖宫产率发生的改变及剖宫产指征因素的变化进行分析，以期对进一步安全有效降低剖宫产率提供有力依据。研究指出在中国剖宫产率降低到15%短期内并不现实，但是在一定时间内降低到30%是可能达到的[3]。这一……