摘要
目的探讨影响紧急剖宫产决定手术至胎儿娩出时间(decision to delivery interval,DDI)的因素及其对母儿结局的影响。方法回顾性分析2021年1至12月在广州市市级和区级妇幼保健院行紧急剖宫产孕产妇的临床资料,根据英国国家卫生与临床优化研究所对紧急剖宫产分类方法及DDI的建议,分为Ⅰ类和Ⅱ类剖宫产;进一步将Ⅰ类剖宫产研究对象分为DDI>30 min组和DDI≤30 min亚组,将Ⅱ类剖宫产分为DDI>75 min组和DDI≤75 min亚组。采用χ2检验或Fisher精确概率法、两独立样本t检验、Mann-Whitney U检验及logistic回归分析影响Ⅰ类和Ⅱ类剖宫产DDI的相关因素及其对母儿结局的影响。结果(1)共502例紧急剖宫产孕产妇纳入分析,其中Ⅰ类剖宫产304例(60.6%)、Ⅱ类剖宫产198例(39.4%)。Ⅰ类剖宫产中DDI≤30 min的比例为30.3%(92/304),Ⅱ类剖宫产中DDI≤75 min的比例为37.4%(74/198)。(2)多因素logistic回归分析发现,Ⅰ类剖宫产中,与全身麻醉比较,椎管内麻醉者DDI>30 min(OR=14.04,95%CI:6.14~32.10)的比例更高;与产房发生紧急情况者比较,病房发生紧急情况者(OR=3.21,95%CI:1.72~6.00)DDI>30 min的风险更高(P值均=0.001)。Ⅱ类剖宫产中,与休息时段比较,日常上班时段DDI>75 min的风险更高(OR=3.93,95%CI:2.03~7.63,P=0.001);与二级妇幼保健院比较,三级妇幼保健院紧急剖宫产的DDI>75 min的风险更大(OR=2.45,95%CI:1.06~5.70,P=0.037)。(3)DDI与母儿结局的关系方面,Ⅰ类剖宫产中,与DDI≤30 min比较,DDI>30 min组的新生儿1 min Apgar评分≤7分的风险更低(OR=0.31,95%CI:0.14~0.69,P=0.004),但DDI分组与新生儿5 min Apgar评分≤7分(OR=0.21,95%CI:0.04~1.17)及新生儿窒息(OR=0.32,95%CI:0.07~1.44)发生风险的关系均无统计学意义(P值均>0.05);Ⅱ类剖宫产中未发现不同DDI对母儿结局影响的差异(P值均>0.05)。结论发现紧急情况的地点、剖宫产麻醉方式是Ⅰ类剖宫产DDI的影响因素;手术时间段、妇幼保健院级别是Ⅱ类剖宫产DDI的影响因素;本研究未发现DDI对母儿结局的影响。
Objective To investigate the factors influencing the decision to delivery interval(DDI)in emergency cesarean section in Guangzhou and the impact of DDI on maternal-infant outcomes.Methods A retrospective study was conducted on clinical data of pregnant women who underwent emergency cesarean section at municipal and district maternal and child health hospitals in Guangzhou city in 2021.Per the classification method of emergency cesarean section and recommendations for DDI provided by National Institute for Health and Clinical Excellence guidelines,these subjects were classified into CategoryⅠand CategoryⅡcesarean sections.Each category was further divided into two subgroups based on DDI:the CategoryⅠgroup into>30 min and≤30 min subgroups,and the CategoryⅡgroup into>75 min and≤75 min subgroups.Chi-square test or Fisher's exact test,two independent samples t-test,Mann-Whitney U test,and logistic regression were used to analyze the potential factors influencing DDI and the impact of DDI on maternal-infant outcomes.Results(1)Totally 502 women underwent urgent cesarean section,including 304(60.6%)CategoryⅠand 198(39.4%)CategoryⅡ,were analyzed.Among the CategoryⅠgroup,30.3%(92/304)achieved a DDI of≤30 min,while 37.4%(74/198)of CategoryⅡcases had a DDI of≤75 min.(2)For the CategoryⅠcases,multivariate logistic regression showed that more patients under intravertebral anesthesia,than those under general anesthesia,had a DDI>30 min(OR=14.04,95%CI:6.14-32.10)as well as more with ward-based emergencies than those with delivery room emergencies(OR=3.21,95%CI:1.72-6.00,both P=0.001).Among the CategoryⅡcases,logistic regression revealed that cesarean section during routine working hours was more likely to achieve DDI>75 min than that during resting hours(OR=3.93,95%CI:2.03-7.63,P=0.001).The risk of DDI>75 min was higher in tertiary maternal and child health hospitals compared with secondary maternal and child health hospitals(OR=2.45,95%CI:1.06-5.70,P=0.037).(3)Among the CategoryⅠcases,compared with the DDI≤30 min group,the DDI>30 min group had a lower risk of neonatal Apgar score≤7 at 1 min(OR=0.31,95%CI:0.14-0.69,P=0.004),but there was no significant difference in the risk of neonatal Apgar score≤7 at 5 min(OR=0.21,95%CI:0.04-1.17)or neonatal asphyxia(OR=0.32,95%CI:0.07-1.44)between the two subgroups.In cases of CategoryⅡcesarean sections,there was no significant difference in any maternal-infant outcomes between DDI≤75 min and DDI>75 min subgroups.Conclusions The location of emergency and types of anesthesia are the influencing factors of DDI for CategoryⅠcesarean sections,while the operation time and level of maternal and child health hospital are the influencing factors of DDI for CategoryⅡcesarean sections.We did not find any impact of DDI on maternal or infant outcome.
作者
刘慧翔
肖辉云
张丽芳
吴颖芳
于佳
沈松英
邱琇
Liu Huixiang;Xiao Huiyun;Zhang Lifang;Wu Yingfang;Yu Jia;Shen Songying;Qiu Xiu(Department of Woman Health,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China;Division of Birth Cohort Study,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2024年第5期353-361,共9页
Chinese Journal of Perinatal Medicine
基金
广州市卫生健康科技项目(2023A031001,20241A011037)。
关键词
紧急剖宫产
决定手术至胎儿娩出时间
妇幼保健机构
Emergency cesarean section
Decision to delivery interval
Maternal and child health hospital
