足月选择性剖宫产时机与新生儿呼吸系统疾病的相关性分析

Relationship between Timing of Elective Cesarean Section at Term and Neonatal Respiratory Disease

目的:评估不同孕周施行足月选择性剖宫产的新生儿呼吸系统疾病的发生风险,确定选择性剖宫产的最佳时机。方法:对2007年12月到2010年11月在山东省立医院行选择性剖宫产的孕产妇及其新生儿进行回顾性分析。孕妇要求分娩孕周在37～39+6周(37～37+6周组、38～38+6周组和39～39+6周组),单胎,无妊娠期合并症和并发症,未破膜或临产。采用单因素方差分析3组孕产妇和新生儿的一般情况;采用卡方检验和Logistic回归分析3组新生儿的呼吸系统疾病的发生风险。结果:共有2094例足月选择性剖宫产纳入研究,37～37+6周组173例,38～38+6周组882例,39～39+6周组1039例。3组不同分娩孕周孕妇新生儿总的呼吸系统疾病发病率分别为6.9%(12/173)、4.5%(40/882)和2.6%(27/1039)。与39～39+6周组相比,37～37+6周组和38～38+6周组的孕妇施行选择性剖宫产可增加新生儿总的呼吸系统疾病的发生风险(P=0.006),37～37+6周组(OR=2.5,95%CI1.2～5.1),38～38+6组(OR=1.8,95%CI1.1～2.9)。进一步分析,妊娠39周之前行选择性剖宫产,其湿肺的发生风险也是明显增加的。结论:妊娠39周之前施行选择性剖宫产较为普遍,但是其会增加新生儿呼吸系统疾病的发生率。

Objective：To evaluate the adjusted odds ratios between the timing of the elective cesarean section performed at term and the neonatal respiratory morbidity, and determining the optimal timing of the elective cesarean section. Methods：We conducted a retrospective study of the women and their neonates, who accepted the elective cesarean section at term in Shandong Province Hospital from December 2007 to November 2010. Women with viable singleton pregnancies delivered before the rupture of fetal membrane, onset of labor and without any pregnant complications between 37 - 39.8 gestational week （38 th gestational week, 39 th gestational week and 40 th gestational week） were included. All maternal and neonatal information were compared with one-way ANOVA in three groups. Neonatal respiratory morbidity in three groups was analyzed by chi-square test and Logistic regression. Results;2094 elective cesarean sections at term preg- nancy were enrolled in this study. 173 cases were at the 38 th gestational week,882 cases at the 39th, gesta- tional week, and 1039 at the 40th gestational week. The incidence of neonatal respiratory morbidity in three groups was 6.9% （12/173） ,4. 5% （40/882） -1 2.6% （27/1039）. Compared to neonates born at the 40th gestational week, neonates born between the 38 th to 39 th gestational weeks were at significantly higher risk for the total respiratory morbidity with elective cesarean section. The absolute risks were 6. 9% （12/173） at the 38 th gestational week, 4. 5% （40/882） at the 39th gestational week compared with 2.6% （27/1039） at the 40 th gestational week（ P = 0. 006）. Adjusted ORs （95% CI） for the total neonatal respiratory morbidity at the 38th and the 39th gestational week were OR=2. 5（95%CI 1.2 -5. 1 ） ,and 1.8（95%CI 1.1 -2.9）. Fur- ther analysis, the risks for wet lung were also significantly higher when elective cesarean sections were performed before the 39 gestational week. Conclusions： Elective cesarean section performed before 39 gestational week is common. Nevertheless, it can increase the incidence of the neonatal respiratory morbidity.