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目的分析足月选择性剖宫产分娩的新生儿不良结局发生的影响因素。方法选择2011年11月至2014年10月在山东大学第二医院行选择性剖宫产的产妇及其新生儿的临床资料进行回顾性分析。收集产妇和新生儿的基本资料。新生儿不良结局包括需转入重症监护室(NICU)治疗和患呼吸系统疾病。利用t检验、卡方检验和二元Logistic回归进行统计学分析。结果共3 290例产妇及其新生儿纳入研究,其中250例新生儿需转NICU治疗,110例新生儿患呼吸系统疾病。影响新生儿转NICU的因素为:产妇产次、体质量指数(BMI)、分娩孕周和新生儿性别;影响新生儿呼吸系统疾病发生的因素为:产妇产次、分娩孕周和新生儿性别。有3次及其以上分娩史的产妇分娩的新生儿发生不良结局的风险明显升高。BMI较低的产妇分娩的新生儿需转NICU的风险降低。37+0~6周分娩的新生儿转NICU的发生风险是39+0~7周的1.9倍(OR=1.9,95%CI=1.2~3.0);37+0~6周和38+0~6周分娩的新生儿呼吸系统疾病的发生风险分别是39+0~7周的2.5倍(OR=2.5,95%CI=1.4~4.7)和1.8倍(OR=1.8,95%CI=1.1~2.7)。男性新生儿呼吸系统疾病和转NICU的发生风险分别是女性新生儿的2.2倍(OR=2.2,95%CI=1.4~3.4)和1.3倍(OR=1.3,95%CI=1.0~1.7),差异均有统计学意义(P<0.05)。结论足月选择性剖宫产的最佳分娩孕周为39~40周;短时间出现产兆后进行的剖宫产未能减少新生儿不良结局的发生;男性新生儿不良结局的发生风险增加;BMI较高和有3次及以上分娩史的产妇分娩的新生儿不良结局发生风险增加。
Objective To analyze the influencing factors of neonatal adverse outcomes in full-term cesarean delivery. Methods From November 2011 to October 2014, we retrospectively analyzed the clinical data of maternal and newborn infants who underwent selective cesarean section at the Second Hospital of Shandong University. Collect basic information on mothers and newborns. Adverse neonatal outcomes include the need to switch to intensive care unit (NICU) treatment and respiratory disease. T-test, chi-square test and binary logistic regression were used for statistical analysis. Results A total of 3 290 mothers and their newborns were enrolled in the study. Among them, 250 newborns needed NICU treatment and 110 newborns had respiratory diseases. The factors influencing the NICU were: maternal birth weight, body mass index (BMI), gestational birth gestational age and neonatal sex; the factors influencing neonatal respiratory diseases were maternal parity, gestational gestational age and neonatal birth Children’s gender. The risk of adverse outcomes in newborns with mothers who have a history of 3 or more deliveries is significantly higher. Neonates with lower BMI maternal deliveries have a reduced risk of having to turn to NICU. The risk of NICU in 37 + 0 ~ 6 weeks of delivery was 1.9 times higher than that of 39 + 0 ~ 7 weeks (OR = 1.9,95% CI = 1.2-3.0) The risks of neonatal respiratory disease delivered at 6 weeks were 2.5-fold (OR = 2.5, 95% CI = 1.4-4.7) and 1.8-fold (OR = 1.8,95% 2.7). Male neonatal respiratory disease and NICU were 2.2 times (OR = 2.2, 95% CI = 1.4 ~ 3.4) and 1.3 times (OR = 1.3, 95% CI = 1.0 ~ 1.7) The differences were statistically significant (P <0.05). Conclusion The optimal gestational gestational age of full-term selective cesarean delivery is 39-40 weeks. Short-term cesarean delivery after birth can not reduce the incidence of adverse neonatal outcomes. The incidence of adverse outcomes in male neonates is increased ; BMI is higher and there are 3 or more births and maternal delivery of neonatal adverse outcomes at increased risk.