剖宫产术后发生肠梗阻的危险因素分析

Analysis of risk factors of intestinal obstruction post cesarean section

目的探讨剖宫产术后发生肠梗阻的危险因素。方法选择2006年1月至2015年10月于北京市上地医院行剖宫产术后发生肠梗阻患者17例作为观察组，另选取同期没有发生肠梗阻的85例患者作为对照组。比较2组年龄、孕产次、孕周、既往手术史、胎膜早破、术前腹痛、产后出血≥800ml、手术时间≥1h、术后镇痛患者比例，采用多因素Logistic回归分析剖宫产术后发生肠梗阻的危险因素。结果2组年龄、孕次、产次、孕周、既往手术史、术后镇痛患者比例差异均无统计学意义（均P〉0．05）。观察组胎膜早破、术前腹痛、产后出血≥800ml、手术时间≥1h患者比例均明显高于对照组[47．1％（8／17）比14．1％（12／85）、47．1％（8／17）比17．6％（15／85）、35．3％（6／17）比16．5％（14／85）、17．6％（3／17）比5．9％（5／85）]，差异均有统计学意义（均P〈0．05）。多因素Logistic回归分析显示，胎膜早破[比值比（OR）=11．652，95％置信区间（ci）：3．059—44．381]、术前腹痛（OR=5．228，95％CI：1．343—20．357）、产后出血≥800rnl（OR=6．845，95％CI：2。402～49．239）是剖宫产术后发生肠梗阻的危险因素（均P〈0。05）。结论术前腹痛、胎膜早破、产后出血≥800ml是剖宫产术后发生肠梗阻的危险因素，

Objective To explore the risk factors of intestinal obstruction after cesarean section. Methods Seventeen patients with intestinal obstruction after cesarean section were enrolled as observation group and 85 cases without intestinal obstruction were selected as control group from January 2006 to October 2015. Age, gestational time, gestational age, previous history of operation, proportions of premature rupture of fetal membrane, preoperative abdominal pain, postpartum hemorrhage ≥ 800 ml, operation time ≥ 1 h and postoperative analgesia between groups were analyzed. Multivariate logistic regression analysis was used to analyze the risk fac- tors of intestinal obstruction after cesarean section. Results Age, gestational time, gestational age, previous his- tory of operation and the proportion of postoperative analgesia had no statistically significant differences between groups （ P 〉 0.05 ）. Proportions of premature rupture of fetal membrane, preoperative abdominal pain, postpartum hemorrhage 9800 ml and operation time ≥ 1 h in observation group were significantly higher than those in control group [47.1% （8/17） vs 14. 1% （12/85）, 47.1% （8/17） vs 17.6% （15/85）, 35.3% （6/17） vs 16. 5% （14/ 85）, 17.6% （3/17） vs 5.9% （5/85） ] （P 〈0. 05）. Multivariate Logistic regression analysis showed that prema- ture rupture of fetal membrane [ odds ratio （OR） = 11. 652, 95% confidence interval （CI） ： 3. 059-44. 381 ], pre- operative abdominal pain （ OR = 5. 228, 95% CI： 1. 343-20. 357 ） , postpartum hemorrhage ≥800 ml （ OR = 6. 845, 95% CI： 2. 402-49. 239） were risk factors of intestinal obstruction after cesarean section （P 〈 0.05 ）. Conclusion Premature rupture of fetal membrane, preoperative abdominal pain, postpartum hemorrhage ≥800 ml are risk factors of intestinal obstruction after cesarean section.