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目的分析该院分娩产妇的临床资料,研究影响该院剖宫产的相关因素,探讨风险校正首次剖宫产率对于产科质量的意义,并为该院妇产科合理控制首次剖宫产率提供临床借鉴。方法对2012年3月-2015年3月在该院妇产科成功分娩的患者资料进行回顾分析,记录所有影响首次剖宫产风险的相关因素,并通过回归分析筛选保护性和危险性因素,组建Logistic方程并对其准确性进行检验,比较风险校正剖宫产率与实际剖宫产率。结果分娩年龄、初产孕妇、多胎妊娠、中度以上妊娠并发症、母亲受教育程度等均是剖宫产的危险因素,与剖宫产率呈正相关(P<0.05);而早产是剖宫产的保护因素,与剖宫产率呈负相关(P<0.05);风险校正首次剖宫产率回归方程:Y=-2.236+0.312×分娩年龄30~35岁+0.952×分娩年龄≥36岁+0.752×初产孕妇+1.548×多胎妊娠-1.056早产+0.864×中度妊娠并发症+1.529×重度妊娠并发症+0.218×母亲受教育程度+2.532×前置胎盘+1.825×胎盘早剥+2.314横位或臀位;ROC曲线下面积为A=0.715,回归方程准确性较高;3年以来,风险校正首次剖宫产率与实际首次剖宫产率均呈下降趋势,差异有统计学意义(P<0.05),且风险校正首次剖宫产率逐渐接近实际首次剖宫产率。结论母亲受教育程度、初产孕妇、多胎妊娠、产时并发症等均是剖宫产的危险因素,而早产(分娩时孕周28~37周)是剖宫产的保护因素;风险校正首次剖宫产率可以较好地评价产科质量,值得临床推广。
Objective To analyze the clinical data of maternal delivery in this hospital and to study the related factors that influence the caesarean section in this hospital and to explore the significance of the risk-corrected first cesarean section rate on the quality of obstetrics and to provide a reasonable cesarean section rate for obstetrics and gynecology in this hospital Clinical reference. Methods The data of patients who were successfully delivered in obstetrics and gynecology from March 2012 to March 2015 were retrospectively analyzed. All the factors affecting the first cesarean section risk were recorded, and the protective and risk factors were screened by regression analysis. Logistic equation was established and its accuracy was tested. The risk-adjusted cesarean section rate and actual cesarean section rate were compared. Results Cesarean section rate was positively correlated with cesarean section rate (P <0.05). The incidence of cesarean section was significantly higher than that of cesarean section (P <0.05); Risk-adjusted regression equation for the first cesarean section rate: Y = -2.236 + 0.312 × childbirth age of 30 to 35 years old + 0.952 × childbirth age of 36 years or older + 0.752 × Maternal + 1.548 × Multiple pregnancy -1.056 Preterm + 0.864 × Moderate pregnancy complications + 1.529 × Severe complications of pregnancy + 0.218 × Maternal education + 2.532 × Placenta previa + 1.825 × Placenta accreta +2.314 Horizontal or breech; the area under the ROC curve is A = 0.715, the regression equation is more accurate; 3 years, the risk-corrected first cesarean section rate and the actual first cesarean section rate showed a downward trend, the difference was statistically significant (P <0.05), and the risk-corrected first cesarean section rate gradually approached the actual first cesarean section rate. Conclusions Maternal education, primiparous women, multiple pregnancies and complications during labor are all risk factors for cesarean section. Premature delivery (gestational weeks 28-37 weeks during childbirth) is the protective factor for cesarean section. Risk correction is first time Cesarean section rate can better evaluate obstetric quality, it is worth clinical promotion.