保产无忧方预防阴道试产后剖宫产的随机对照研究  

Prophylactic Efficacy of Baochan Wuyou Recipe for Cesarean Delivery after Trial of Labor: a Randomized Controlled Study

作　　者：童美和[1] 于海微[1] 毛乾国[2] 吴英英 林锦芬[1] 林晓燕[1] 蔡玲端 TONG Mei-he;YU Hai-wei;MAO Qian-guo;WU Ying-ying;LIN Jin-fen;LIN Xiao-yan;CAI Ling-duan(Department of Obstetrics,Xiamen Hospita/of Traditiona/ Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine,Fujian（361009;Department of Infectious Diseases,Xiamen Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine,Fujian（361009)

机构地区：[1]福建中医药大学附属厦门中医院产科,福建361009 [2]福建中医药大学附属厦门中医院感染性疾病科,福建361009

出　　处：《中国中西医结合杂志》2018年第11期1312-1315,共4页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：厦门市科技局科技惠民项目(No.3502Z20164038)

摘　　要：目的明确保产无忧方预防阴道试产后剖宫产的有效性。方法采用随机对照方法 ,将390例宫内单胎足月妊娠、头位、轻微头盆不称的初产妇分为中药组和对照组,每组各195例。中药组在有临产先兆后,开始服用保产无忧方,对照组不服用中药,两组均按常规观察及处理产程;比较两组发生剖宫产的比例和分娩方式的构成比。借助于二分类多变量Logistic回归分析筛选和评估阴道分娩的独立危险因素。结果中药组和对照组发生剖宫产的比例分别为24.6%(48/195)和45.1%(88/195),差异有统计学意义(χ~2=18.064,P<0.01);中药组发生剖宫产的相对危险度为0.545(95%置信区间:0.408-0.729)。二分类多变量Logistic回归分析结果显示,与剖宫产者比较,阴道分娩者口服中药的优势比(odds ratio,OR)为2.519 (95%置信区间:1.637-3.876),以产妇身高和新生儿体重校正后的OR为2.874(95%置信区间:1.823-4.531)。中药组的顺产、阴道助产、剖宫产3种分娩方式的构成比分别为70.8%(138/195)、4.6%(9/195)、24.6%(48/195),对照组分别为39.5%(77/195)、15.4%(30/195)、45.1%(88/195),两组比较,差异有统计学意义(χ~2=40.379,P<0.01)。结论 轻微头盆不称的初产妇,在出现临产先兆后开始服用保产无忧方,能降低发生阴道试产后剖宫产的风险。Objective To identify the prophylactic efficacy of Baochan Wuyou Recipe （BWR） for cesarean delivery after trial of labor. Methods Totally 390 primiparas were recruited in this study and randomized into TCM group or control group, 195 in each group. Inclusion criteria were pregnancy in term, single birth, primiparity, cephalic presentation, and mild cephalopelvic disproportion. Gravidas in the TCM group took BWR after threatened labor, while those in control group took no TCM. All patients received routine labor management. The proportion of cesarean delivery and the constituent ratio of delivery mode were compared. Binary Logistic regression analysis was used to screen and evaluate independ- ent risk factors associated with vaginal delivery. Results The proportions of cesarean delivery in TCM group and control group were 24.6% （48/195）and 45.1% （88/195） respectively （X2 = 18.064, P 〈0.01 ）. Relative risk was 0. 545 （95% CI： 0.408 -0. 729）. Binary Logistic regression analysis indicated, as compared with the cesarean delivery puerperas, odds ratio （OR） of taking BWR in vaginal delivery puerperas was 2.519 （~95% CI： 1. 637 -3. 876）. The multivariate-adjusted OR was 2.874 （95% CI： 1. 823 - 4.531 ） （P 〈0.01 ） after adjusted by height of expectant mother and body weights of neonates. Constituent ratios of spontaneous, operative vaginal delivery, cesarean delivery were 70.8% （138/195）, 4.6% （9/195）, and 24.6% （48/195）, respectively in the TCM group, and they were 39.5% （77/195）, 15.4% （30/195）, and 45.1% （88/195）, respectively in the control group （X2 = 40.379 ,P 〈0.01 ）. The difference existed between the two groups （X2 = 40.379 ,P 〈0.01 ）. Conclusion Primiparas with mild cephalopelvic disproportion started to take BWR at the onset of threatened labor could reduce the risk of cesarean delivery after trial of labor.

关 键 词：保产无忧方 阴道试产 剖宫产 头盆不称 

分 类 号：R271.9[医药卫生—中西医结合]