五年前后产钳助产相关因素变化的临床研究

Clinical research of the related factor of changed forceps delivery in five years

目的探讨本院5年前后产钳助产相关因素的变化及其对临床结局的影响。方法分别对2008年1月-12月期间海淀区妇幼保健院住院产钳助产产妇425例，及2014年1月-12月期间住院产钳助产产妇914例的相关因素进行回顾性分析。结果产钳助产的主要指征排在前三位的依次为胎儿窘迫、第二产程延长（胎头下降停滞）和枕位不正，2008年产钳助产的枕位以枕前位为主，2014年枕横位和枕后位则明显增加。产钳助产侧切率由2008年的99．5％降至2014年的79．4％（x2=96．24，P〈0．01），差异有统计学意义。产钳助产的主要操作者中2008年主治医师占59．1％，而2014年主治医师占80．3％（x2=138．73，P〈0．01），差异有统计学意义。产钳助产的主要并发症有：软产道裂伤和产后出血，且产后出血量无变化（t=1．18，P〉0．05），但2014年尿潴留发生率较高（x2=17．87，P〈0．01）。2008年有3．8％新生儿有并发症，而2014年则降至1．86％。但分娩后住院时间：2014年比2008年明显缩短（t=6．56，P〈0．01）。结论只要严格掌握产钳适应证，高年资住院医师以上均可操作；并发症的程度与操作者的技术有很大关系；产钳助产可行选择性会阴侧切术。

Objective To investigate the related factor of changed forceps delivery in five years and its influence on clinical result. Methods 425 cases from January to December in 2008 and 914 cases from January to December in 2014 underwent maternal hospital delivery with low forceps were retrospectively analyzed . Results The main application indications of forceps were fetal distress, prolonged second stage of labor （arrested descent ）and fetal head malposition. Oecipitoanterior was mainly in 2008, occipitotransverse and occipitoposterior increased in 2014.The rate of lateral episiotomy descent from 99.7% in 2008 to 79.4 % in 2014 （X2=96.24, P〈 0.01） .The main operators were attending physicians, occupied significantly from 59.1% in 2008 to 80.3%in 2014. Maternal complications were soft birth canal laceration （X 2=1.60, P〉0.05）, the blood volume of postpartum hemorrhage （t=-1.18, P〉0.05）, postpartum urinary retention （X2=17.87, P〈 0.01 ）and neonatal complications （X2=4.37, P〈 0.01 ）.The length of stay after parturition is less from 2008 to 2014 （t=6.56, P〈 0.01）.Conclusion As long as mastering the indications of obstetrical forceps, senior resident can operate the techinque. The severity degree of complications had relationship with the skills of the operator. Forceps delivery may apply lateral episiotomy selectively.