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目的探讨运用PDCA循环法控制剖宫产手术改进干预方法,从而降低剖宫产率。方法选取2011年8~12月及2012年5月~2013年3月在该院分娩的产妇12 008例,其中剖宫产4 402例。将产妇分为干预前组3 280例,其中剖宫产1 374例;干预后组8 728例,其中剖宫产3 028例。应用PDCA循环管理模式对剖宫产指征进行回顾性分析,并制订整改措施。结果实施PDCA循环管理后,剖宫产率由干预前的41.89%降低至干预后的34.69%,差异有统计学意义(P<0.001)。干预前剖宫产指征依次为:妊娠合并症、选择性剖宫产、胎儿不良因素、头位难产、臀位妊娠、瘢痕子宫、胎盘因素。干预后剖宫产指征前3位为:妊娠合并症、胎儿不良因素、选择性剖宫产,选择性剖宫产及妊娠合并症构成比显著性降低,差异有统计学意义(P<0.05)。结论 PDCA循环法可有效应用于降低剖宫产率管理中,是一种值得推广的管理模式。
Objective To explore the use of PDCA cycle control cesarean section to improve the intervention method, thereby reducing the cesarean section rate. Methods A total of 12 008 maternal births were delivered in this hospital from August to December in 2011 and May to March in 2013. Among them, 4 402 cases of cesarean section were delivered. The mothers were divided into 3 280 cases before the intervention group, of which 1 374 cases of cesarean section; after the intervention group 8 728 cases, of which 3 028 cases of cesarean section. Retrospective analysis of indications for cesarean section using PDCA cycle management model and development of corrective measures. Results After PDCA cycle management, the cesarean section rate decreased from 41.89% before intervention to 34.69% after intervention, the difference was statistically significant (P <0.001). Cesarean section indication before intervention were as follows: pregnancy complications, selective cesarean section, fetal adverse factors, head dystocia, breech pregnancy, scar uterus, placenta factors. The first three indications for cesarean section after intervention were as follows: the gestational complications, adverse fetal factors, selective cesarean section, selective cesarean section and gestational complications were significantly decreased (P <0.05 ). Conclusion PDCA circulation method can be effectively applied to reduce the rate of cesarean section management, is a worthy promotion of management.