足月选择性剖宫产分娩新生儿不良结局的影响因素  

Influencing factors of adverse outcomesin term neonates delivered by elective caesarean

作　　者：洪海洁[1] 孙文娟[1] 张媛[2] 徐永萍[1] 

机构地区：[1]山东大学第二医院产科,山东济南250033 [2]山东大学第二医院循证医学中心,山东济南250033

出　　处：《山东大学学报（医学版）》2016年第5期56-61,73,共7页Journal of Shandong University:Health Sciences

摘　　要：目的分析足月选择性剖宫产分娩的新生儿不良结局发生的影响因素。方法选择2011年11月至2014年10月在山东大学第二医院行选择性剖宫产的产妇及其新生儿的临床资料进行回顾性分析。收集产妇和新生儿的基本资料。新生儿不良结局包括需转入重症监护室（NICU）治疗和患呼吸系统疾病。利用t检验、卡方检验和二元Logistic回归进行统计学分析。结果共3 290例产妇及其新生儿纳入研究,其中250例新生儿需转NICU治疗,110例新生儿患呼吸系统疾病。影响新生儿转NICU的因素为：产妇产次、体质量指数（BMI）、分娩孕周和新生儿性别;影响新生儿呼吸系统疾病发生的因素为：产妇产次、分娩孕周和新生儿性别。有3次及其以上分娩史的产妇分娩的新生儿发生不良结局的风险明显升高。BMI较低的产妇分娩的新生儿需转NICU的风险降低。37＋0~6周分娩的新生儿转NICU的发生风险是39＋0~7周的1.9倍（OR=1.9,95%CI=1.2~3.0）;37＋0~6周和38＋0~6周分娩的新生儿呼吸系统疾病的发生风险分别是39＋0~7周的2.5倍（OR=2.5,95%CI=1.4~4.7）和1.8倍（OR=1.8,95%CI=1.1~2.7）。男性新生儿呼吸系统疾病和转NICU的发生风险分别是女性新生儿的2.2倍（OR=2.2,95%CI=1.4~3.4）和1.3倍（OR=1.3,95%CI=1.0~1.7）,差异均有统计学意义（P〈0.05）。结论足月选择性剖宫产的最佳分娩孕周为39~40周;短时间出现产兆后进行的剖宫产未能减少新生儿不良结局的发生;男性新生儿不良结局的发生风险增加;BMI较高和有3次及以上分娩史的产妇分娩的新生儿不良结局发生风险增加。Objective To analyze the influencing factors of adverse outcomes in neonates delivered at term by elective caesarean. Methods Clinical data of mothers and babies delivered by elective caesarean section during Nov. 1,2011 and Oct. 31,2014 at the Second Hospital of Shandong University were retrospectively reviewed. The neonatal adverse outcomes were analyzed with t-test,chi-square test and logistic regression analysis,including transference to NICU and respiratory diseases. Results A total of 3,290 mothers and their neonates were enrolled,of which 250 neonates needed to be transferred to NICU,and 110 neonates developed a respiratory disease. The factors that caused the neonates to be transferred to NICU were parity,BMI,delivery gestational age and fetal sex. The factors that caused the neonates to develop a respiratory disease were parity,delivery gestational age and fetal sex. The risk of adverse outcomes in neonates whose mothers parity was three times and above was significantly higher. The risk of transference to NICU was lower in neonates delivered by mothers with smaller BMI. The risk of transference to NICU for neonates delivered in37＋ 0-6weeks was 1. 9 times than those delivered in 39＋ 0-7weeks（ OR = 1. 9,95% CI = 1. 2-3. 0）. The risk of respiratory disease for neonates delivered in 37＋ 0-6weeks and 38＋ 0-6weeks were respectively 2. 5 times and 1. 8 times than those delivered in 39＋ 0-7weeks（ OR = 2. 5,95% CI = 1. 4-4. 7 and OR = 1. 8,95% CI = 1. 1-2. 7）. The risk of a respiratory disease and transference to NICU in male neonates were respectively 2. 2 times and 1. 3 times than in female neonates（ OR = 2. 2,95% CI = 1. 4 ~ 3. 4 and OR = 1. 3,95% CI = 1. 0-1. 7）. The differences were statistically significant（ all P 0. 05）. Conclusion The best delivery gestational age for elective cesarean section is 39-40 weeks. Cesarean sections conducted shortly after onset of labor do not reduce the risk of neonatal adverse outcomes. The risk of adverse outcomes in male neonates is higher tha

关 键 词：足月 剖宫产 选择性 新生儿不良结局 影响因素 

分 类 号：R719.8[医药卫生—妇产科学]