【摘要】：目的:在對延安大學附屬醫(yī)院5年以來經陰道試產失敗中轉剖宮產手術指征和分娩結局的臨床資料統計整理的基礎上,分析陰道試產失敗中轉剖宮產手術指征構成比變化,比較不同產程中轉剖宮產對分娩結局的影響,為提出有效的干預措施以及選擇中轉剖宮產的最佳時機提供理論依據,以期達到降低陰道試產失敗中轉剖宮產率和改善不良分娩結局的目的。方法:選取延安大學附屬醫(yī)院2012年1月1日至2016年12月31日5年期間的34777例住院分娩產婦,將其中843例陰道試產失敗中轉剖宮產的產婦作為臨床研究對象,針對其中轉剖宮產率、中轉剖宮產手術指征、不同產程中轉剖宮產對分娩結局的影響進行回顧性分析。結果:1.2012年至2016年分娩總數逐年增加,2013年剖宮產率最高為53.13%,2015年最低為40.89%,平均剖宮產率為45.88%;2012年和2016年的中轉剖宮產率分別為5.24%和3.56%,兩者相比呈下降變化,差異有統計學意義(P=0.000)。2.5年期間以胎兒窘迫為中轉剖宮產手術指征一直居于第一位或第二位;以產程異常為中轉剖宮產手術指征由第一位下降為第三位;以社會因素為中轉剖宮產手術指征一直居于第三位或第四位;以相對頭盆不稱為中轉剖宮產手術指征由第四位上升至第二位。其他中轉剖宮產手術指征順位無變化。3.第二產程中轉剖宮產的產婦其胎頭娩出困難率、子宮切口延伸率、子宮收縮乏力率、產后出血率、術后發(fā)熱率、腹部切口感染率均明顯高于第一產程,差異有統計學意義(P0.05)。4.第二產程中轉剖宮產新生兒的窒息率明顯高于第一產程,差異有統計學意義(P0.05)。結論:1.總剖宮產率、陰道試產失敗中轉剖宮產率均呈下降變化,但仍然處于較高水平。2.胎兒窘迫是中轉剖宮產重要手術指征之一,以相對頭盆不稱為中轉剖宮產手術指征呈上升變化。降低陰道試產失敗中轉剖宮產率,需關注胎兒窘迫和相對頭盆不稱手術指征。3.第二產程中轉剖宮產母嬰并發(fā)癥發(fā)生率均高于第一產程。因此,盡量避免在第二產程中轉剖宮產,若需第二產程中轉剖宮產應加強預防產后母嬰并發(fā)癥發(fā)生的措施。4.加強對孕期、分娩時的管理;嚴格把握中轉剖宮產手術指征;早發(fā)現、早診斷、早處理產程中出現的異常情況,盡最大努力降低中轉剖宮產率和改善不良分娩結局的發(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.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R719.8

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