首次急症剖宫产术从决定手术至切皮时间间期与母婴结局的关系

Decision-to incision interval and maternal and infant outcomes

目的：研究急症剖宫产术从决定手术至切皮时间间期（DII）与母婴结局的相关性，评估昆明医学院第一附属医院目前对产科急症的应急能力。方法：对2000年1月1日～2006年9月30日期间在产科住院分娩的部分急症剖宫产术（ECS）进行回顾性队列研究，比较不同DII时间段ECS母婴的不良妊娠结局。结果：在纳入本研究的735例首次ECS病例中，DII的分布范围为10—310min，仅9例（1．2％）的ECS达到DII≤30min；ECS的指征按照构成比依次为：活跃期头位难产383例（52．2％），胎儿窘迫320例（43．8％），脐带脱垂12例（1．6％），胎盘早剥10例（1．4％），前置胎盘10例（1.4％），本研究病例中无子宫破裂和剖宫产术中脏器损伤者；以DII30min为组距将病例分为6组，各组间母亲和新生儿不良结局的发生率均无统计学显著差异；将相同病例分为DII≤75min和DII〉75min两组，两组间母亲和新生儿不良结局的发生率也没有显著统计学差异；以活跃期头位难产为指征的383例以及以胎儿宫内窘迫为指征的320例病例分为DII≤75min和DII〉75min两组，两组间母亲和新生儿不良结局的发生率均无显著统计学差异。结论：该院真实医疗现状极难达到DII≤30min的国际标准。在以非危急ECS指征为主的一般急症剖宫产中，未发现DII〉75min增加母婴不良结局。

Objective： To measure the relation between decision - to incision interval and maternal and neonatal outcomes in a cobert of women undergoing emergency cesarean deliveries at the first Affiliated Hospital of Kunming Medical College, and evaluate the response to the obstetric emergency circumstances. Methods： All women undergoing a primary cesarean delivery at our hospital during a 6 year and 9 month span were ascertained. Emergency procedures were defined as those performed for umbilical cord prolapse, placental abruption, placenta previa with hemorrhage, non- reassuring fetal heart rate pattern, dystocia in cephalic presentation and uterine rupture. Detailed information regarding maternal and neonatal outcomes, as well as the interval from the decision time to perform cesarean delivery to the actual skin incision, were collected. Results： 735 were performed for an emergency indication. Of these, only 1. 2% began within 30 minutes of the decision to operate. The majority of ECS indications were non - reassuring heart rate tracings and dystocia in cephalic presentation. No maternal operative injury and uterine rupture occurred. Comparing with infants delivered within 75 minutes, there were no differences in maternal or infant outcomes for decision to incision interval more than 75 minutes. Conclusion： In our hospital, the international standards of DII 〈 30 minutes is difficult to be achieved. For the non - crash Cesarean section DII more than 75 minutes didn＇t be found to be associated with poorer maternal and infant outeomes.