放置IUD服务质量与IUD下移取器关系的巢式病例对照研究

A Nested Case-control Study on IUD's Removal due to Downward Dislocation about Quality of Care for Women in Rural Areas in Yunnan Province

目的:探讨云南省农村地区育龄妇女IUD下移取器与手术人员服务质量间的关联。方法:采用巢式病例对照研究方法,从队列中获得246例IUD下移取器病例,按1:1的比例分别匹配以末次妊娠结局、所置IUD种类相同、地区、年龄相当的对照,调查分析为此组患者施术人员的相关服务质量。结果:单因素条件logistic回归分析显示施术人员本调查置器时间点前一年(2004年)所置IUD数量、是否有计划生育手术上岗合格证、5年内IUD相关培训次数、置环、取环术熟练程度、对放置IUD绝对禁忌证的了解程度、所施行过的手术种类与IUD下移取器有统计学关联(P<0.05),进一步用多因素条件logistic回归分析,施术人员5年内IUD相关培训次数、2004年置环数量、置环、取环术熟练程度与IUD下移取器有统计学关联(P<0.05),OR值分别为0.35(95%CI:0.18～0.66)、0.50(95%CI:0.33～0.77)和2.46(95%CI:1.89～3.20),其他各因素对致育龄妇女IUD下移取器未显示有统计学意义。结论:影响IUD下移取器有关服务质量的因素包括施术人员的服务水平和培训情况,今后需进一步探讨IUD技术服务质量管理模式,提高人民的生殖健康水平。

Objective：To explore the potential relevant risk factors of IUD＇s removal due to downward dislocation about quality of care for women in rural areas in Yunnan Province.Methods：A 1：1 nested casecontrol study was carried out,246 cases were obtained from cohort study,and every case was matched with one control with same region,age,type of IUD and the result of last pregnancy.Results：From the analysis of univariate conditional logistic regression model,several factors were found to have statistically significant association with IUD＇s removal due to downward dislocation,including operator＇s number of operation in 2004,operator＇s surgery certification of family planning,training in 5 years,proficiency of operation,operator＇s knowing operating contraindications,kinds of operator＇s working.Further analysis of multivariate conditional logistic regression model showed that operator＇s training in 5 years,the number of operation in 2004 and proficiency of operation had statistical associations with the risk of IUD＇s removal due to downward dislocation,and odds ratios were 0.35（95 %CI：0.180.66）,0.50（95 % CI：0.33-0.77）,2.46（95 %CI：1.89-3.20）,respectively.Others were found no significant association with the risk of IUD＇s removal due to downward dislocation.Conclusion：Operator＇s levels of service and training were the major factors of IUD＇s removal due to downward dislocation,we should further improve quality of care and establish the quality management pattern.