选择性剖宫产的相关因素研究

Related Factors of Elective Cesarean Section： A Cue-Control Study

目的 总结广州市番禺区妇幼保健院在过去十年剖宫产率的变化和趋势,分析2009年该院病人相关的和医师相关的因素与选择性剖宫产的关系.方法 这是一个病例对照研究,病例是应病人自己要求或手术指征不明确的选择性剖宫产分娩的妇女,对照则是有明确手术指征的剖宫产分娩妇女.PS power软件用于计算样本量,通过分层随机抽样的方法,在4176个2009年住院分娩的病历中随机抽取709个总样本（其中病例数是348个,对照是361个）.通过病历回顾,收集所有与病人相关的及与医生相关的非医学因素.采用SPSS 16.0软件进行数据处理,运用卡方检验和Logistic回归方程进行检测.结果 该院的剖宫产率从2000年的41.8%到2009年的59.9%,总体呈一个线性的提高.选择性剖宫产更多发生在正常上班时间,产检次数越多的病人越容易在无手术指征的情况下选择剖宫产.结论 在本研究人群中,产科医师的偏好影响病人对剖宫产的选择,医师便利及害怕医疗纠纷可能是医师选择治疗方式的主要驱动因素.因此,选择性剖宫产率的控制措施应更侧重于改变医师的行为模式,而不仅仅是患者教育.

Objective To summarize the trend of CSR at a district public hospital in Guangzhou in the past decade and to identify patient and physician-related factors for elective cesarean section in 2009.Methods This was a case-control study. All available non-medical risk factors were collected from inpatient medical records. PS power software was used to calculate sample size. Cases were women who underwent Cesarean delivery at maternal recquest or for unclear obstetric indication and controls were women who underwent Cesarean delivery with one or more medical indications. A total sample size of 709 （348 cases and 361 controls） was obtained via stratified random sampling from 4176 in-patient delivery records in 2009.Risk factors for CS were examined in Chi-square test and logistic regression models. Results In our hospital, the total CSR increased in a linear manner from 41.8% in 2000 to 59.9% in 2009. Hour of delivery was a significant predictor for ECS. The odds of ECS were higher during normal work hours than outside normal work hours. More frequent prenatal visits were significantly associated with ECS. Conclusion In study population, women who labour during normal working hours or access to more sufficient prenatal care have higher probability to undergo ECS. These present findings suggest that obstetrician＇s preference involve in maternal request for elective cesarean section. Physicians＇ convenience incentive and fear of being sued might be the potential drivers of their preference. Therefore the controlling of elective cesarean delivery is more likely to be a process of changing obstetrician practice pattern than of patient education.