27例会阴重度裂伤的临床分析

Clinical analysis of 27 cases of severe perineal laceration

目的通过对27例分娩时发生会阴重度裂伤病例的临床资料进行分析,探讨会阴重度裂伤的高危因素。方法选择安徽医科大学附属妇幼保健院2016年2月—2019年4月间收治的27例会阴重度裂伤患者作为观察组,同时按照1∶2比例选取相邻住院号经阴道分娩产妇54例作为对照组。调阅2组病历资料,比较2组产妇的临床特点,分析会阴重度裂伤的高危因素。采用成组t检验、χ^2检验及二分类logistic回归分析对数据进行分析。结果会阴重度裂伤的发生率为27/28 334(95.29/10万);观察组产时出血量及产后尿潴留发生率高于对照组(均P<0.05),观察组发现会阴重度裂伤后进行及时修补,术后管理排便并应用抗菌素,远期预后良好。Logistic回归分析显示孕妇BMI(OR=7.552,95%CI为2.136~26.696)和新生儿体重(OR=20.511,95%CI为4.552~92.421)是会阴重度裂伤的独立危险因素;2组孕妇年龄、器械助产、会阴侧切、分娩镇痛、助产士年资、分娩时段等比较差异无统计学意义(均P>0.05)。结论新生儿体重、孕妇BMI是会阴重度裂伤的高危因素,管理孕期增重、控制新生儿体重对于减少会阴重度裂伤的发生有积极意义。

Objective To explore the high-risk factors of severe maternal perineal tears by analyzing the clinical data of 27 cases.Methods The case group enrolled 27 cases of severe maternal perineal tear after a vaginal delivery in Anhui Maternal and Child Health Hospital from February 2016 to April 2019.A total of 54 pregnant women who has adjacent hospitalization number as a control group according to 1∶2 ratio.The clinical data of case and control group were compared by two-sample t-test,χ^2 test and binary logistic regression.Results The incidence of severe perineal tears was 27/28334(95.29/100000).The Bleeding volume after delivery and incidence of postpartum urinary retention in study group was higher than that in the control group(P<0.05),the severe maternal perineal tear in study group were repaired immediately,and guided defecation,used antibiotic after surgery.The long-term prognosis of them are good.The single factor analysis showed that there were statistically significant differences in Maternal BMI(OR=7.552,95%CI:2.136 to 26.696)and neonatal weight(OR=20.511,95%CI:4.552 to 92.421)between the two groups(P<0.05).There was no statistically significant difference in age,forceps delivery,episiotomy,labor analgesia,midwife’s seniority and delivery period between the two groups(all P>0.05).Conclusion High maternal BMI and neonatal weight are the high-risk factors of severe maternal perineal tears.Pregnant women increase their weight reasonably and control neonatal weight has a positive effect on reducing the occurrence of severe perineal tears.