重庆地区高龄孕妇重复剖宫产围术期危险因素调查  

Investigation on perioperative risk factors for repeat cesarean delivery in elderly pregnant women in Chongqing

作　　者：黄立[1] 张世焱 秦方东 陈竹 周子淞 罗玲 张吉培 刘超 李应清[7] 纪成城 HUANG Li;ZHANG Shiyan;QIN Fangdong;CHEN Zhu;ZHOU Zisong;LUO Ling;ZHANG Jipei;LIU Chao;LI Yingqing;JI Chengcheng(Department of Anesthesiology,Chongqing Seventh People′s Hospita,Chongqing 400054,China;Department of Anesthesiology,Wansheng Economic District People′s Hospital,Chongqing 400800,China;Department of Anesthesiology,Dadukou District People′s Hospital,Chongqing 400084,China;Department of Anesthesiology,Nanchuan District People′s Hospital,Chongqing 408400,China;Department of Anesthesiology,Hongren Hospital of Nanchuan District,Chongqing 408400,China;Department of Anesthesiology,Pengshui County People′s Hospital,Chongqing 409600,China;Department of Anesthesiology,Qijiang District People′s Hospital,Chongqing 400800,China;Department of Anesthesiology,Jiangbei District Hospital of Traditional Chinese Medicine,Chongqing 400023,China)

机构地区：[1]重庆市第七人民医院麻醉科,400054 [2]重庆市万盛经开区人医院麻醉科,400800 [3]重庆市大渡口区人民医院麻醉科,400084 [4]重庆市南川区人民医院麻醉科,408400 [5]重庆市南川区宏仁医院麻醉科,408400 [6]重庆市彭水县人民医院麻醉科,409600 [7]重庆市綦江区人民医院麻醉科,400800 [8]重庆市江北区中医院麻醉科,400023

出　　处：《重庆医学》2022年第8期1397-1401,共5页Chongqing medicine

基　　金：重庆市科卫联合医学科研青年项目(2019QNXM009)。

摘　　要：目的探究重庆地区高龄重复剖宫产孕妇的围术期风险特征。方法通过系统整群抽样调查方法,选取2014-2019年重庆市8个地区19家二级甲等及以上医疗机构13769例重复剖宫产孕妇为研究对象,按分娩年龄分为高龄组(分娩年龄大于或等于35岁),适龄组(分娩时年龄在18~<35岁),对比分析2组产妇临床特征和麻醉方式的选择。结果高龄组重复剖宫产孕妇2215例(16.09%),适龄组11554例(83.91%)。高龄组孕周小于适龄组[38.86(38.28,39.28)周vs.39.00(38.42,39.28)周,Z=-7.111,P<0.001];高龄组产时BMI、宫高、腹围均高于适龄组[(28.09±3.37)kg/m2 vs.(27.76±3.42)kg/m2、(34.20±2.59)cm vs.(33.84±2.56)cm、(103.70±7.03)cm vs.(102.47±7.28)cm,均P<0.001];高龄组脐带绕颈、妊娠糖尿病、胎膜早破、巨大儿、胎盘植入、妊娠高血压、低体重儿、前置胎盘发生率均高于适龄组(分别为31.66%vs.29.14%、22.54%vs.11.87%、10.68%vs.7.95%、7.85%vs.5.95%、3.92%vs.2.81%、3.83%vs.1.45%、2.97%vs.2.24%、1.51%vs.0.79%,均P<0.05);高龄组术中出血量大于适龄组[350(300,450)mL vs.300(300,400)mL,P<0.001];高龄组促子宫收缩药物使用种数多于适龄组(χ^(2)=30.257,P<0.001);高龄组全身麻醉、产后出血、宫体捆绑、宫腔纱布填塞发生率大于适龄组(1.37%vs.0.80%,0.87%vs.0.42%,5.70%vs.3.85%,3.38%vs.1.79%,均P<0.01);2组间其余变量比较差异无统计学意义(P>0.05)。结论重庆地区重复剖宫产孕妇以适龄妇女为主。与适龄重复剖宫产孕妇比较,高龄重复剖宫产孕妇具有更多的高危妊娠风险因素,且孕期合并症和产时并发症发生率增加,需要高度重视高龄重复剖宫产孕妇围术期管理。Objective To explore the perioperative risk characteristics of elderly pregnant women with repeated cesarean delivery in Chongqing.Methods A total of 13769 pregnant women with repeated cesarean delivery in 19 second class A or above medical institutions were selected in eight regions of Chongqing from 2014 to 2019 by systematic cluster sampling method.They were divided into the advanced age group(age of delivery≥35 years old)and the appropriate age group(≤age of delivery between 18-<35 years old)according to their age of delivery.The clinical characteristics and anesthesia methods of the two groups were compared and analyzed.Results There were 2215 pregnant women(16.09%)in the advanced age group and 11554 pregnant women(83.91%)in the appropriate age group.The gestational age of the advanced age group was less than that of the appropriate age group[38.86(38.28,39.28)vs.39.00(38.42,39.28),Z=-7.111,P<0.001].The BMI,uterine height and abdominal circumference of the advanced age group were higher than those of the appropriate age group[(28.09±3.37)vs.(27.76±3.42)kg/m2,(34.20±2.59)vs.(33.84±2.56)cm,(103.70±7.03)vs.(102.47±7.28)cm,all P<0.001].The incidence of umbilical cord around the neck,gestational diabetes mellitus,premature rupture of membranes,macrosomia,placenta accreta,pregnancy induced hypertension and low birth weight and placenta previa in the advanced age group were higher than those in the appropriate age group(31.66%vs.29.14%,22.54%vs.11.87%,10.68%vs.7.95%,7.85%vs.5.95%,3.92%vs.2.81%,3.83%vs.1.45%,2.97%vs.2.24%,1.51%vs.0.79%,all P<0.05).The amount of intraoperative blood loss in the advanced age group was larger than that in the appropriate age group[350(300,450)mL vs.300(300,400)mL,P<0.001].The number of drugs used to promote uterine contraction in the advanced age group was more than that in the appropriate age group(χ^(2)=30.257,P<0.001).The incidence of general anesthesia,postpartum hemorrhage,uterine binding and uterine gauze packing in the advanced age group were higher than those in the

关 键 词：高龄孕妇 重复剖宫产 围手术期 临床特征 

分 类 号：R719.8[医药卫生—妇产科学]