医务人员对非医学指征剖宫产影响因素的认知  

Cognition of influencing factors of cesarean section without medical indications among medical staff

作　　者：朱丽萍[1] 秦敏[1] 花静[1] 董海燕[1] 宋晶晶[1] 

机构地区：[1]上海市妇女保健所.同济大学附属第一妇婴保健院,200040

出　　处：《中国妇幼保健》2014年第7期1083-1086,共4页Maternal and Child Health Care of China

基　　金：上海市卫生政策课题〔2013HP045〕;上海市市级医院适宜技术项目〔SHDC12012231〕;上海市公共卫生三年行动计划〔20112013〕;上海市卫生与计划生育委员会科技重点项目〔20114010〕

摘　　要：目的：了解医务人员对非医学指征剖宫产影响因素和降低剖宫产率（“降剖”）策略的知晓情况，从而为建立综合性“降剖”干预策略提供依据。方法：2013年6月份，对上海市83家助产医疗机构的医务人员进行问卷调查，共发放问卷135份，回收133份。利用Logistic回归模型多因素分析，在控制可能混杂因素后，分析医务人员剖宫产决策的影响因素。结果：绝大多数医务人员认为非医学指征剖宫产率主要受到孕产妇认知（98．50％）和家属意愿（82．71％）的影响。并认为健康教育（97．74％）、镇痛技术（87．22％）和提高接产技能（72．18％）是降低非医学指征剖宫产的有效手段。多因素分析结果显示，在控制了医务人员学历、职称、专业、产科工作年限后等混杂因素后，同意“剖宫产对产妇健康存在危害”（OR=13．455；95％C12．609—69．397）和“子代健康存在危害”（OR=4．810；95％CI1．405—16．472）的医务人员决策孕妇采用阴道分娩的可能性更高。“愿意从事孕产期健康教育工作”（OR：3．462；95％CI1．008～11．889）的医务人员决策亲戚朋友采用阴道分娩的可能性更高。结论：根据研究结果，将加强健康教育、加强医务人员培训提高助产技术水平以及制定相关政策作为“降剖”的政策建议。Objective： To understand the awareness of influencing factors of cesarean section without medical indications and the strategies of reducing cesarean section rate among medical staff, and provide a basis for establishing comprehensive intervention strategies of reducing cesarean section rate. Methods： The medical staff from 83 maternity hospitals in Shanghai city in June 2013 were investigated by a questionnaire, a total of 135 questionnaires were issued and 133 questionnaires were retrieved; after controlling confounding factors, the in- fluencing factors of decision of cesarean section made by medical staff were analyzed by multivariate logistic regression analysis. Results： According to the opinions of most medical professionals, the cognition of pregnant women （98.5%） and willingness of their relatives （82. 7% ） mainly affected the rate of cesarean section without medical indications..Health education （97.74%）, analgesic technique （87.22%） , and midwifery skills （72. 18% ） were effective methods to reduce cesarean section without medical indications; after controlling confounding factors, such as academic background, professional title, profession, and work years, the medical staff agreeing with the opinion of ＂cesarean section having harm to pregnant women＂ （ OR = 13.455 ; 95% CI： 2. 609 - 69. 397 ） and ＂ cesarean section having harm to health of the children＂ （ OR =4. 810; 95% CI 1. 405 - 16. 472） had higher probability to adopt vaginal delivery; the medical staff agreeing with the opinion of willingness of taking part in maternal health care （ OR = 3. 462 ; 95% CI 1. 008 - 11. 889 ） had higher probability to a- dopt vaginal delivery when their relatives got pregnancy. Conclusion： According to the results of present study, enhancing health education, training of medical staff, improving midwifery skills, and formulating related strategies were considered as the suggestions for reducing cesare- an section.

关 键 词：医务人员 非医学指征剖宫产影响因素认知 

分 类 号：R719[医药卫生—妇产科学]