剖宫产取胎时间对新生儿脐动脉血气分析的影响

Effect of cesarean section time on the blood gas analysis of umbilical artery in neonates

目的探讨剖宫产取胎时间的影响因素及取胎时间对新生儿脐动脉血气分析的影响。方法选择2014年4月~2016年4月择期剖宫产手术的469例产妇,采用COX风险比例回归分析产妇的年龄、孕周、体重指数、切口方向、胎头入盆情况、胎位、有无瘢痕子宫及新生儿体重各因素对取胎时间的影响;进一步分析取胎时间与新生儿脐动脉各血气参数的相关关系,比较取胎时间对脐动脉血气参数的影响。结果 (1)体重指数(BMI)≥30[风险函数(HR)=1.75,95%可信区间(95%CI)1.35~2.27]、瘢痕子宫(HR=1.26,95%CI 1.01~1.56)、异常胎位(HR=1.55,95%CI 1.19~2.01)、巨大儿(HR=1.94,95%CI 1.48~2.55)是延长取胎时间的主要因素;(2)取胎时间与新生儿脐动脉血气值p H、PO_2、BE负相关(r=-0.61,P<0.01;r=-0.25,P<0.05;r=-0.36,P<0.05),与PCO2、Lac正相关(r=0.43,P<0.01;r=0.52,P<0.01);(3)随着取胎时间延长,脐动脉p H≤7.10、p H≤7.20、PO_2≤14.0 mm Hg、PCO2≥65 mm Hg、BE≤-8 mmol/L及Lac≥8 mmol/L的发生率增加(P<0.01);(4)与取胎时间≤120 s相比,取胎时间>120 s明显增加新生儿脐动脉p H≤7.10(RR=1.10,95%CI 1.01~1.18)和p H≤7.20的危险度(RR=1.72,95%CI 1.38~2.15)。结论剖宫产取胎时间是影响新生儿脐动脉血气分析的重要因素之一,取胎时间延长,新生儿呼吸性酸中毒发生率明显增加;而产妇BMI≥30、瘢痕子宫、异常胎位及巨大儿是影响取胎时间的主要因素。

Objective To study the influencing factors of cesarean section delivery time and the effect of delivery time on＇blood gas analysis of umbilical artery in neonates. Methods 469 puerpera receiving selective cesaren section from April 2014 to April 2016 were selected. The effects of factors such as age of puerpera, gestational age, body mass index, incision direction, fetal head engagement, fetal position, scarring uterus and neonatal body weight on delivery time were analyzed by COX risk ratio regression analysis; the relationship between delivery time and blood gas parameters of neonatal umbilical artery was further analyzed. The effect of delivery time on blood gas parameters of umbilical artery was compared. Results （1）Body mass index（BMI）≥30 [Risk function （HR）=1.75, 95% confidence interval （95% CI） 1.35- 2.27], scar uterus （HR=1.26, 95% CI 1.01-1.56）, abnormal fetal position （HR=1.55, 95% CI 1.19-2.01）, and macrosomia （HR=1.94, 95% CI 1.48-2.55） were the main factors of extending the delivery time; （2） Delivery time was negatively correlated with blood gas parameters of neonatal umbilical artery pH, PO2 and BE （r=-0.61, P〈0.01; r=-0.25, P〈0.05; r=-0.36, P〈0.05）, and the delivery time was positively correlated with PCO2 and Lac（r=0.43, P〈0.01; r=0.52, P〈0.01）; （3）With the extension of deliVery time, the incidence rate of umbilical artery phi〈7.10, pHi〈7.20, PO2≤ 14.0 mmHg, PCO2≥65 mmHg, BE ≤-8 mmol/L and Lac ≥ 8 mmol/L was increased（P〈0.01）; （4）Compared with the delivery time ≤ 120 s, delivery time〉 120 s significantly increased the risk degree of pH ≤7.10（RR=1. 10, 95%CI 1.01-1.18） and pH ≤ 7.20（RR=1.72, 95%CI 1.38-2.15） of neonatal umbilical artery. Conclusion Cesarean section delivery time is one of the important factors influencing the blood gas analysis of umbilical artery in neonates. The delivery time is significantly prolonged, and the incidence rate of neonatal respiratory acidosis is significantly increased; maternal BMI ≥30, scar uterus, abnormal fetal position and macrosomia are the main factors affecting the delivery time.