紧急剖宫产手术时间的影响因素分析
|
摘要
目的:探讨紧急剖宫产手术时间的影响因素。方法:收集行紧急剖宫产手术孕妇366例,收集剖宫产分类、手术指征、手术时间及手术开始至胎儿娩出时间(DDI)等指标,分析影响手术时间的影响因素。结果:Ⅰ类剖宫产的手术时间和DDI均明显少于于Ⅱ类(P<0.01);瘢痕子宫孕妇的手术时间和DDI均高于非瘢痕子宫者(P<0.05);胎儿窘迫、相对性头盆不称、胎位不正、出血量高的孕妇手术时间均低于无以上指征者(P<0.05～P<0.01);胎儿窘迫、胎盘早剥、相对性头盆不称孕妇的DDI均低于无以上指征者(P<0.05～P<0.04)。多水平单因素分析结果显示,胎儿窘迫、相对性头盆不称、瘢痕子宫、胎位不正、出血量、剖宫产类型与孕妇剖宫产手术时间有关(P<0.05～P<0.01);胎儿窘迫、胎盘早剥、相对性头盆不称、瘢痕子宫、剖宫产类型与DDI有关(P<0.05～P<0.01)。结论:紧急剖宫产手术指征和出血量与手术时间有关,缩短手术时间有助于减少手术出血量以及母儿各种并发症的发生。
Objective:To explore the influencing factors of the operation time in urgent cesarean section.Methods:The cesarean section type,surgical indicators,total operation time and operation time from the beginning to delivery(DDI) in 366 cases treated with urgent caesarean section were investigated,and the influencing factors of the operation time were analyzed.Results:The total operation time and operation time from the beginning to delivery in class Ⅰ cesarean section were shorter than those in class Ⅱ cesarean section(P<0.01).The total operation time and operation time from the beginning to delivery in pregnant women with scar uterus were shorter than those in pregnant women without scar uterus(P<0.05).The total operation time in patients with fetal distress,relative cephalopelvic disproportion,malposition and more hemorrhage were shorter than that in patients without above indicators(P<0.05 to P<0.01).The operation time from the beginning to delivery in patients with fetal distress,placental abruption and relative cephalopelvic disproportion were shorter than that in patients without above indicators(P<0.05 to P<0.01).The results of multilevel univariate analysis showed that fetal distress,relative cephalopelvic disproportion,scar uterus,placental deviation,blood loss and cesarean section type were related to the operation time of cesarean section(P<0.05 to P<0.01),and the fetal distress,placental abruption,relative cephalopelvic disproportion,scar uterus and cesarean section type were related to the DDI(P<0.05 to P<0.01).Conclusions:The indicators of urgent cesarean section and amount of blood loss are related to the operation time.Shortening the total operation time may reduce the operative blood loss and incidence rate of maternal and neonatal complication.
Objective:To explore the influencing factors of the operation time in urgent cesarean section.Methods:The cesarean section type,surgical indicators,total operation time and operation time from the beginning to delivery(DDI) in 366 cases treated with urgent caesarean section were investigated,and the influencing factors of the operation time were analyzed.Results:The total operation time and operation time from the beginning to delivery in class Ⅰ cesarean section were shorter than those in class Ⅱ cesarean section(P<0.01).The total operation time and operation time from the beginning to delivery in pregnant women with scar uterus were shorter than those in pregnant women without scar uterus(P<0.05).The total operation time in patients with fetal distress,relative cephalopelvic disproportion,malposition and more hemorrhage were shorter than that in patients without above indicators(P<0.05 to P<0.01).The operation time from the beginning to delivery in patients with fetal distress,placental abruption and relative cephalopelvic disproportion were shorter than that in patients without above indicators(P<0.05 to P<0.01).The results of multilevel univariate analysis showed that fetal distress,relative cephalopelvic disproportion,scar uterus,placental deviation,blood loss and cesarean section type were related to the operation time of cesarean section(P<0.05 to P<0.01),and the fetal distress,placental abruption,relative cephalopelvic disproportion,scar uterus and cesarean section type were related to the DDI(P<0.05 to P<0.01).Conclusions:The indicators of urgent cesarean section and amount of blood loss are related to the operation time.Shortening the total operation time may reduce the operative blood loss and incidence rate of maternal and neonatal complication.
引文
[1] GRACE L,GREER RM,KUMAR S.Perinatal consequences of a category 1 caesarean section at term[J].BMJ Open,2015,5(7):e007248.
[2] LUCAS DN,YENTIS SM,KINSELLA SM,et al.Urgency of caesarean section:anew classification[J].J R Soc Med,2000,93(7):346.
[3] 马可心,张为远.紧急剖宫产术的决定手术到胎儿娩出时间[J].中华妇产科杂志,2017,52(2):134.
[4] THOMAS J,PARANJOTHY S,JAMES D.National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section[J].BMJ,2004,328:665.
[5] TUFFNELL DJ,WILKINSON K,BERESFORD N.Interval between decision and delivery by caesarean section—are current standards achievable? Observational case series[J].BMJ,2001,322(7298):1330.
[6] WEINER E,BAR J,FAINSTEIN N,et al.The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome[J].Am J Obstet Gynecol,2014,210(3):224.
[7] GUPTA S,NAITHANI U,MADHANMOHAN,et al.Evaluation of decision-to-delivery interval in emergency cesarean section:A 1-year prospective audit in a tertiary care hospital[J].J Anaesthesiol Clin Pharmacol,2017,33(1):64.
[8] TOLCHER MC,JOHNSON RL,EL-NASHAR SA,et al.Decision-to-incision time and neonatal outcomes:a systematic review and meta-analysis[J].Obstet Gynecol,2014,123(3):536.
[9] GANGWAR R,CHAUDHARY S.Caesarean section for foetal distress and correlation with perinatal outcome[J].J Obstet Gynaecol India,2016,66(1):177.
[10] MACDORMAN MF,MENACKER F,DECLERCQ E.Cesarean birth in the United States:epidemiology,trends,and outcomes[J].Clin Perinatol,2008,35(2):293.
[11] GHAHEH HS,FEIZI A.Risk factors of placental abruption[J].J Res Med Sci,2013,18(5):442.
[2] LUCAS DN,YENTIS SM,KINSELLA SM,et al.Urgency of caesarean section:anew classification[J].J R Soc Med,2000,93(7):346.
[3] 马可心,张为远.紧急剖宫产术的决定手术到胎儿娩出时间[J].中华妇产科杂志,2017,52(2):134.
[4] THOMAS J,PARANJOTHY S,JAMES D.National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section[J].BMJ,2004,328:665.
[5] TUFFNELL DJ,WILKINSON K,BERESFORD N.Interval between decision and delivery by caesarean section—are current standards achievable? Observational case series[J].BMJ,2001,322(7298):1330.
[6] WEINER E,BAR J,FAINSTEIN N,et al.The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome[J].Am J Obstet Gynecol,2014,210(3):224.
[7] GUPTA S,NAITHANI U,MADHANMOHAN,et al.Evaluation of decision-to-delivery interval in emergency cesarean section:A 1-year prospective audit in a tertiary care hospital[J].J Anaesthesiol Clin Pharmacol,2017,33(1):64.
[8] TOLCHER MC,JOHNSON RL,EL-NASHAR SA,et al.Decision-to-incision time and neonatal outcomes:a systematic review and meta-analysis[J].Obstet Gynecol,2014,123(3):536.
[9] GANGWAR R,CHAUDHARY S.Caesarean section for foetal distress and correlation with perinatal outcome[J].J Obstet Gynaecol India,2016,66(1):177.
[10] MACDORMAN MF,MENACKER F,DECLERCQ E.Cesarean birth in the United States:epidemiology,trends,and outcomes[J].Clin Perinatol,2008,35(2):293.
[11] GHAHEH HS,FEIZI A.Risk factors of placental abruption[J].J Res Med Sci,2013,18(5):442.