【摘要】：目的:在對(duì)延安大學(xué)附屬醫(yī)院5年以來(lái)經(jīng)陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征和分娩結(jié)局的臨床資料統(tǒng)計(jì)整理的基礎(chǔ)上,分析陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征構(gòu)成比變化,比較不同產(chǎn)程中轉(zhuǎn)剖宮產(chǎn)對(duì)分娩結(jié)局的影響,為提出有效的干預(yù)措施以及選擇中轉(zhuǎn)剖宮產(chǎn)的最佳時(shí)機(jī)提供理論依據(jù),以期達(dá)到降低陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)率和改善不良分娩結(jié)局的目的。方法:選取延安大學(xué)附屬醫(yī)院2012年1月1日至2016年12月31日5年期間的34777例住院分娩產(chǎn)婦,將其中843例陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)的產(chǎn)婦作為臨床研究對(duì)象,針對(duì)其中轉(zhuǎn)剖宮產(chǎn)率、中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征、不同產(chǎn)程中轉(zhuǎn)剖宮產(chǎn)對(duì)分娩結(jié)局的影響進(jìn)行回顧性分析。結(jié)果:1.2012年至2016年分娩總數(shù)逐年增加,2013年剖宮產(chǎn)率最高為53.13%,2015年最低為40.89%,平均剖宮產(chǎn)率為45.88%;2012年和2016年的中轉(zhuǎn)剖宮產(chǎn)率分別為5.24%和3.56%,兩者相比呈下降變化,差異有統(tǒng)計(jì)學(xué)意義(P=0.000)。2.5年期間以胎兒窘迫為中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征一直居于第一位或第二位;以產(chǎn)程異常為中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征由第一位下降為第三位;以社會(huì)因素為中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征一直居于第三位或第四位;以相對(duì)頭盆不稱為中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征由第四位上升至第二位。其他中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征順位無(wú)變化。3.第二產(chǎn)程中轉(zhuǎn)剖宮產(chǎn)的產(chǎn)婦其胎頭娩出困難率、子宮切口延伸率、子宮收縮乏力率、產(chǎn)后出血率、術(shù)后發(fā)熱率、腹部切口感染率均明顯高于第一產(chǎn)程,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.第二產(chǎn)程中轉(zhuǎn)剖宮產(chǎn)新生兒的窒息率明顯高于第一產(chǎn)程,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.總剖宮產(chǎn)率、陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)率均呈下降變化,但仍然處于較高水平。2.胎兒窘迫是中轉(zhuǎn)剖宮產(chǎn)重要手術(shù)指征之一,以相對(duì)頭盆不稱為中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征呈上升變化。降低陰道試產(chǎn)失敗中轉(zhuǎn)剖宮產(chǎn)率,需關(guān)注胎兒窘迫和相對(duì)頭盆不稱手術(shù)指征。3.第二產(chǎn)程中轉(zhuǎn)剖宮產(chǎn)母嬰并發(fā)癥發(fā)生率均高于第一產(chǎn)程。因此,盡量避免在第二產(chǎn)程中轉(zhuǎn)剖宮產(chǎn),若需第二產(chǎn)程中轉(zhuǎn)剖宮產(chǎn)應(yīng)加強(qiáng)預(yù)防產(chǎn)后母嬰并發(fā)癥發(fā)生的措施。4.加強(qiáng)對(duì)孕期、分娩時(shí)的管理;嚴(yán)格把握中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征;早發(fā)現(xiàn)、早診斷、早處理產(chǎn)程中出現(xiàn)的異常情況,盡最大努力降低中轉(zhuǎn)剖宮產(chǎn)率和改善不良分娩結(jié)局的發(fā)生。
[Abstract]:Objective: on the basis of statistical analysis of clinical data of indications and outcome of cesarean section during the failure of vaginal trial delivery in the hospital affiliated to Yanan University in the past 5 years, the change of the index ratio of indications for cesarean section during the failure of vaginal trial delivery was analyzed. To compare the effects of cesarean section in different stages of labor on the outcome of labor, to provide theoretical basis for effective intervention and the choice of optimal time for cesarean section. The aim is to reduce the rate of cesarean section and improve the bad delivery outcome. Methods: 34777 hospitalized parturients were selected from the affiliated Hospital of Yan'an University from January 1, 2012 to December 31, 2016. Among them, 843 women who failed in vaginal trial delivery were selected as the clinical study objects. According to the rate of cesarean section, the indication of cesarean section and the influence of different stages of cesarean section on the outcome of labor, this paper analyzed retrospectively the effect of cesarean section on the outcome of labor. Results: 1. The total number of births increased year by year from 2012 to 2016, the highest rate of cesarean section was 53.13 in 2013, the lowest was 40.89 in 2015, and the average cesarean section rate was 45.88; The rates of caesarean section in 2012 and 2016 were 5.24% and 3.56%, respectively. The difference was statistically significant (P0. 000). During 2.5 years, fetal distress was always the first or second indication of cesarean section. The indication of cesarean section with abnormal labor process decreased from the first to the third, and the social factor was always the third or the fourth. The relative cephalopelvic is not called transitional cesarean section from the fourth to the second. The indications of other transmissible cesarean section were not changed. 3. The rate of fetal head delivery difficulty, uterine incision elongation, uterine contraction fatigue, postpartum hemorrhage rate, postoperative fever rate, abdominal incision infection rate were significantly higher in the second stage of labor than in the first stage of labor. The difference was statistically significant (P0.05). 4. The asphyxia rate of newborns transferred to cesarean section in the second stage of labor was significantly higher than that in the first stage of labor (P0.05). Conclusion: 1. The total rate of cesarean section and the rate of conversion to cesarean section during the failure of vaginal trial delivery were all decreased, but were still at a high level of 2.2%. Fetal distress is one of the important indications of cesarean section. To reduce the rate of caesarean section during vaginal trial labor failure, we should pay attention to fetal distress and the indication of relative cephalopelvic disproportion. The incidence of complications in the second stage of labor converted to cesarean section was higher than that in the first stage of labor. Therefore, to avoid the second stage of labor transfer cesarean section, if the second stage of cesarean section should be strengthened to prevent the occurrence of postpartum complications. 4. Strengthen the management of pregnancy and delivery; strictly grasp the indications of the transition to cesarean section; early detection, early diagnosis, early treatment of abnormal conditions in the labor process, do their utmost to reduce the rate of transition cesarean section and improve the occurrence of bad delivery outcome.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R719.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊曉冰;;無(wú)痛分娩對(duì)降低剖宮產(chǎn)率的價(jià)值及對(duì)剖宮產(chǎn)指征的影響[J];醫(yī)學(xué)理論與實(shí)踐;2017年01期

2 鄭媛媛;鄒麗穎;范玲;;新產(chǎn)程標(biāo)準(zhǔn)實(shí)施后產(chǎn)程中剖宮產(chǎn)指征的變化及母兒預(yù)后分析[J];中華婦產(chǎn)科雜志;2016年04期

3 彭婷;李笑天;;過(guò)度診斷胎兒窘迫的原因分析與解決之道[J];實(shí)用婦產(chǎn)科雜志;2016年03期

4 曾曉明;鄭九生;鄒衛(wèi);;新產(chǎn)程標(biāo)準(zhǔn)處理產(chǎn)程2632例分析[J];江西醫(yī)藥;2015年07期

5 侯磊;李光輝;鄒麗穎;李長(zhǎng)東;陳奕;阮焱;王欣;賈朝霞;張為遠(yuǎn);;全國(guó)剖宮產(chǎn)率及剖宮產(chǎn)指征構(gòu)成比調(diào)查的多中心研究[J];中華婦產(chǎn)科雜志;2014年10期

6 漆洪波;楊慧霞;段濤;;關(guān)注和采納正常產(chǎn)程和產(chǎn)程異常的新標(biāo)準(zhǔn)[J];中華婦產(chǎn)科雜志;2014年07期

7 肖嬋云;肖梅;;237例臨產(chǎn)后中轉(zhuǎn)剖宮產(chǎn)手術(shù)指征分析[J];中國(guó)婦幼健康研究;2014年01期

8 劉海俠;;247例陰道試產(chǎn)失敗轉(zhuǎn)剖宮產(chǎn)的原因分析[J];中國(guó)醫(yī)藥指南;2013年29期

9 柯淑蘭;;陰道試產(chǎn)中轉(zhuǎn)剖宮產(chǎn)113例臨床分析[J];臨床護(hù)理雜志;2013年01期

10 王君榮;魏雙梅;;持續(xù)性枕后位、枕橫位的處理體會(huì)[J];中國(guó)實(shí)用醫(yī)藥;2010年35期

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