【摘要】：目的：剖宮產(chǎn)術(shù)是處理高危妊娠、異常分娩、挽救孕產(chǎn)婦和圍生兒生命的有效手段。隨著各種剖宮產(chǎn)術(shù)式的成熟與完善,其他相關(guān)醫(yī)學(xué)領(lǐng)域的發(fā)展,使剖宮產(chǎn)的安全性大大提高,在臨床上得到廣泛應(yīng)用；研究證實(shí)剖宮產(chǎn)率的升高在一定范圍內(nèi)可以降低孕產(chǎn)婦及圍產(chǎn)兒的死亡率；社會(huì)經(jīng)濟(jì)迅速發(fā)展,計(jì)劃生育的大力推廣,胎兒尤為珍貴,且孕婦對(duì)陰道分娩缺乏信心,要求行剖宮產(chǎn)；醫(yī)患矛盾及醫(yī)療糾紛的逐漸增加,沒(méi)有健全的醫(yī)療法律法規(guī),制約了產(chǎn)科醫(yī)生選擇臨床治療策略等,這些因素促使我國(guó)的剖宮產(chǎn)率成為世界第一,并引起國(guó)內(nèi)外產(chǎn)科領(lǐng)域的廣泛關(guān)注。因此探討高剖宮產(chǎn)率的原因及控制剖宮產(chǎn)率成為目前研究的焦點(diǎn)。鑒于此,本研究通過(guò)分析7年間剖宮產(chǎn)率及剖宮產(chǎn)指征的變化,為控制剖宮產(chǎn)率提出合理的措施,指導(dǎo)孕婦選擇合理的分娩方式,提高產(chǎn)科質(zhì)量。方法：回顧性分析2006年1月至2012年12月山西醫(yī)科大學(xué)第一醫(yī)院產(chǎn)科6402例行剖宮產(chǎn)手術(shù)分娩產(chǎn)婦的病例資料,描述7年間剖宮產(chǎn)率及剖宮產(chǎn)指征的變化情況。 結(jié)果： (1)剖宮產(chǎn)率總體呈下降趨勢(shì),差異有統(tǒng)計(jì)學(xué)意義(χ2=205.717,P=0.0010.05)。 (2)7年的剖宮產(chǎn)指征變化中,妊娠合并癥及并發(fā)癥(χ2=43.906,P=0.0010.05)、瘢痕子宮(χ2=118.738,P=0.0010.05)總體呈上升趨勢(shì),差異有顯著性；社會(huì)因素(χ2=26.069,P=0.0010.05)、胎兒窘迫(χ2=6.679,P=0.010.05)總體呈下降趨勢(shì),差異有顯著性；其余各項(xiàng)指征所占比率各年相比基本持平。 (3)在妊娠合并癥及并發(fā)癥的疾病構(gòu)成中,構(gòu)成比由高到低依次為妊娠期高血壓疾病、妊娠合并內(nèi)外科疾病、前置胎盤及胎盤早剝、糖尿病、ICP(Intrahepatic cholestasis of pregnancy,妊娠期肝內(nèi)膽汁淤積癥)。 結(jié)論： (1)總體來(lái)看,7年間剖宮產(chǎn)率呈下降趨勢(shì)。 (2)在剖宮產(chǎn)指征構(gòu)成中,妊娠合并癥及并發(fā)癥成為主要原因,并呈逐漸上升趨勢(shì),在妊娠合并癥及并發(fā)癥疾病構(gòu)成中,妊娠期高血壓疾病居于首位,其次依次為妊娠合并內(nèi)外科疾病、前置胎盤及胎盤早剝、糖尿病、ICP。 (3)社會(huì)因素的剖宮產(chǎn)率呈下降趨勢(shì)。 (4)對(duì)胎兒窘迫有了新認(rèn)識(shí),嚴(yán)格定義胎兒窘迫,故胎兒窘迫的剖宮產(chǎn)率呈下降趨勢(shì)。 (5)瘢痕子宮的剖宮產(chǎn)率呈上升趨勢(shì)。
[Abstract]:Objective: cesarean section is an effective method to deal with high-risk pregnancy, abnormal delivery and save the life of pregnant women and perinatal. With the maturity and perfection of various cesarean sections and the development of other related medical fields, the safety of cesarean section has been greatly improved and widely used in clinic. Studies have proved that the increased rate of cesarean section can reduce maternal and perinatal mortality to a certain extent; the rapid development of social economy, the vigorous promotion of family planning, the special value of the fetus, and the lack of confidence in vaginal delivery by pregnant women. The increasing conflicts between doctors and patients and medical disputes, the lack of sound medical laws and regulations have restricted obstetricians from choosing clinical treatment strategies. These factors have made the cesarean section rate in our country the first in the world. It has attracted wide attention in the field of obstetrics at home and abroad. Therefore, to explore the causes of high cesarean section rate and control the cesarean section rate has become the focus of current research. In view of this, this study analyzed the changes of cesarean section rate and indications of cesarean section in seven years, and put forward reasonable measures to control the rate of cesarean section, guiding pregnant women to choose reasonable delivery mode and improve the quality of obstetrics. Methods: the data of 6402 cases of parturient undergoing cesarean section in the first Hospital of Shanxi Medical University from January 2006 to December 2012 were analyzed retrospectively and the changes of cesarean section rate and indications of cesarean section were described. Results: (1) the rate of cesarean section showed a downward trend, and the difference was statistically significant (蠂 ~ 2 / 205.717 / P ~ 0.0010.05). (_ 2). In the changes of indications of cesarean section in 7 years, complications of pregnancy and complications (蠂 ~ (2) 43.906 / P ~ (0.0010.05) and scarred uterus (蠂 ~ (2118.738P ~ 0.0010.05) showed an overall upward trend (蠂 ~ 2118.738P _ (0.0010.05). Social factors (蠂 2 + 26.069) and fetal distress (蠂 2 + 6.679%) showed a decreasing trend (蠂 2 + 6.679%), the difference was significant, and the percentage of other indications was basically the same. (3) in the disease composition of pregnancy complication and complication, there was no significant difference between the two groups. The order of composition ratio from high to low is hypertensive disorder complicating pregnancy, pregnancy with internal and surgical diseases, placenta previa and placental abruption, and intrahepatic cholestasis of pregnancy with diabetes mellitus (ICP (Intrahepatic cholestasis of pregnancy,). Conclusion: (1) the rate of cesarean section has been decreasing in the past seven years. (2) the complications and complications of pregnancy are the main causes of cesarean section. Among the complications and complications of pregnancy, hypertensive disorder complicating pregnancy was the first, followed by pregnancy with internal and surgical diseases, placenta previa and placental abruption. ICP. (3) the cesarean section rate of social factors is decreasing. (4) there is a new understanding of fetal distress, and a strict definition of fetal distress, Therefore, the cesarean section rate of fetal distress decreased. (5) the cesarean section rate of scar uterus increased.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R719.8

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