风险校正首次剖宫产率与产科质量的评估  

Risk-adjusted primary cesarean delivery rates and quality assessment of obstetric care

作　　者：刘铭[1] 马润玫[1] 陈芳[1] 肖虹[1] 田玉芹[1] 李白鸾[1] 杨明晖[1] 

机构地区：[1]昆明医学院第一附属医院妇产科,昆明650032

出　　处：《现代妇产科进展》2007年第12期888-892,共5页Progress in Obstetrics and Gynecology

基　　金：云南省科技厅攻关项目;国际合作资助项目(No:2001NG51;2003GH06)

摘　　要：目的：分析与剖宫产分娩（CD）相关的危险因素，通过比较实际首次CD率与风险校正首次CD率的关系评估我院产科质量。方法：回顾研究2003年1月至2007年4月在我院分娩符合纳入标准的6752例产妇的病历。从总体数据中随机抽取25％的数据建立Logistic回归方程，其余75％的数据以接受者工作特征曲线下面积建立的Logistic回归方程进行检验。某年所有产妇CD概率的均值即为该年风险校正首次CD率。结果：（1）初产妇、分娩年龄≥30岁、母亲高学历、多胎妊娠、妊娠合并症及并发症和产时并发症CD的风险增加，早产CD的风险降低；（2）我院近5年实际首次CD率逐年降低，由2003年的59．38％降至2006年-2007年4月的38．82％，实际首次CD率与相应的风险校正首次CD率差值逐年缩小，至2006年-2007年4月实际首次CD率已接近风险校正首次CD率。结论：（1）我院实际首次CD率逐渐接近风险校正首次CD率，反映了我院产科质量稳步提升；（2）风险校正首次CD率是评估产科质量的可靠指标之一。Objective：To investigate the risk factors of cesarean delivery （CD） and to evaluate the quality of obstetric care in our obstetric unit by comparing the risk-adjusted primary CD rates with observed primary CD rates. Methods：6752 births were analysed retrospectively between Jan. 2003 and April 2007 in our hospital. A multivariate logistic regression model of characteristics independently associated with CD was developed with the use of a random 25% sample of the data,the model was validated on the 75% portion of the data that were not used to build the model and an A statistic was calculated. The A statistic refers to the area under the receiver operating characteristic curve, A statistic above 0.7 indicate acceptable discrimination. Using the model,the probability of a CD was determined for every patient in the database. The risk-adjusted primary CD rate for a hospital in each year was calculated by an average of the CD probabilities of each patient who delivered at the hospital in each year. Results： （ 1 ） Nulliparity, maternal age ≥ 30 years, maternal advanced education, multiple pregnancies, maternal medical conditions and intrapartum complications were the risk factors of CD, while premature was protective against CD. （2）Both the observed primary CD rates and the risk-adjusted primary CD rates had decreased over the past 5 years with the lowest level in 2006-April. 2007. Conclusions： （1）The differences between the observed primary CD rates and the risk-adjusted primary CD rates gradually decreased, reflecting improved quality of obstetric care at our hospital. （2） Risk-adjusted primary CD rate is a reasonable standard for assessment the quality of obstetric

关 键 词：剖宫产 风险校正 产科质量 

分 类 号：R719.8[医药卫生—妇产科学]