“两孩政策”后大型综合医院剖宫产产妇结构变化初探

Preliminary exploration on composition changes of cesarean parturients in large tertiary hospitals after the two-child policy

目的探讨"两孩政策"后剖宫产产妇结构变化及对临床的影响。方法回顾性分析遵义医学院附属医院2015年09~11月及2016年09~11月行剖宫产术患者的全部手术信息。以年份为分组依据,比较年龄、体质量、ASA分级、疤痕子宫率、合并症率、急诊率在内的产妇结构数据及术前、术后生命体征、检验结果、住院时间、补液及输血在内的围术期管理数据,并以是否急诊为依据行分层分析。结果共收集样本1048例,其中2015年组490例; 2016年组558例。2015年组与2016年组比较,产妇总体结构数据差异无统计学意义(P> 0. 05);但2016年组异体红细胞(RBC)输注率> 2015年组(10. 57%vs 4. 69%),2016年组血浆输注率> 2015年组(4. 12%vs 1. 22%),差异有统计学意义(P <0. 05)。分层分析中,2016年组择期手术产妇年龄的(30. 89±5. 04)岁>同组急诊的(29. 60±5. 18)岁及2015年组择期的(29. 68±5. 32)岁,差异有统计学意义(P <0. 05);2016年组择期产妇疤痕子宫合并率49. 18%、合并症发生率36. 75%均高于同组急诊手术的39. 94%及13. 13%,同时高于2015年组择期手术的42. 06%及16. 55%,差异有统计学意义(P <0. 05)。2016年组择期手术异体红细胞输注率10. 27%、急诊手术异体红细胞输注率10. 72%均高于2015年组择期手术的3. 89%及急诊手术的5. 05%,差异有统计学意义(P <0. 05)。结论"两孩政策"后剖宫产产妇结构已发生明显改变,其中择期手术产妇影响较大,且该变化已直接影响围术期的输血管理,临床须重点关注。

ObjectiveTo investigate the composition changes of parturients with cesarean after the two-child policy and its influences on clinical care. MethodsA retrospective analysis was carried out on all cesarean surgeries in our hospital between September 11, 2015 and September 11, 2016. The patients were grouped according to the year of surgery, and data collected included parturient information （age, body weight, ASA status, rate of scar uterus, complication rate, whether emergency or not） and perioperative management information （preoperative and postoperative basic vital signs, laboratory results, perioperative fluid infusion, blood transfusion amount, length of hospital stays）. Subgroup analysis was performed based on whether the cesarean was an emergency surgery. Results A total of 1048 cases were collected, with 490 cases in year 2015 group and 558 cases in year 2016 group. There were no statistically significant differences between 2015 group and 2016 group in the demographics of parturients （ P 〉0.05）. But the transfusion rate of allogeneic RBC in 2016 group （10.57%） was greater than that in 2015 group （4.69%）, and the transfusion rate of fresh frozen plasma in 2016 group （4.12%） was greater than that in 2015 group （1.22%）, with statistically significant differences （ P 〈0.05）. In subgroup analysis, the age of parturients undergoing elective surgery in 2016 group （30.89±5.04 year） was elder than those of emergency surgery in 2016 group （29.60±5.18 year） and parturients with elective surgery in 2015 group （29.68±5.32 year）, with statistically significant differences （ P 〈0.05）. Rate of Scar uterus （49.18%） and complication incidence （36.75%） of the parturients with elective surgery in 2016 group were higher than those （39.94% and 13.13%） of the parturients with emergency surgery in 2016 group, and higher than those （42.06% and 16.55%） of the parturients with elective surgery in 2015 group, with statistically significant differences （ P 〈0.05）. Blood transfusion rate （10.27%） of the elective surgery and blood transfusion rate （10.72%） of the emergency surgery in 2016 group were all higher than those （3.89% for elective surgery and 5.05% for emergency surgery） in 2015 group, with statistically significant differences （ P 〈0.05）.Conclusion Composition of parturients with cesarean has obviously changed after the two-child policy and the influence was especially larger on parturients undergoing elective surgery. In particular, these changes exhibited direct impacts on perioperative blood transfusion management, which derserves special attention in clinical care.