孕妇肥胖与剖宫产术中、术后并发症发生的关系

Relationship Between Obesity of Pregnant Women and Complications During and After Cesarean Section

目的分析孕妇肥胖与剖宫产术中、术后并发症的关系,以期为剖宫产并发症的防治工作提供参考依据。方法选择2018年5月~2019年5月我院收治的足月行剖宫产分娩的孕妇368例作为研究对象,按照体重指数(BMI)分为三组,将孕前BMI≥25 kg/m2的125例设为孕前肥胖组,将分娩前BMI>28 kg/m2的119例设为产前肥胖组,另将孕前BMI为17~24 kg/m2的124例设为正常对照组。比较三组麻醉时间、手术时间、开腹至娩出胎头时间、术中出血量、术后伤口愈合情况、住院时间以及切口脂肪液化发生率。结果孕前肥胖组麻醉时间、开腹至娩出胎头时间、手术时间均较正常对照组时间稍延长,但差异无统计学意义(P>0.05);产前肥胖组麻醉时间、开腹至娩出胎头时间、手术时间均较正常对照组时间延长,术后并发症、血栓性疾病发生率、腹壁切口脂肪液化发生率高于对照组(P<0.05);孕、产前肥胖组术中出血量较正常对照组增多,血栓性疾病发生率高于对照组,差异无统计学意义(P>0.05);孕前肥胖组术后孕妇术后并发症、切口脂肪液化发生率高于对照组(P<0.05);孕、产前肥胖组术后住院时间均长于对照组(P<0.05)。结论孕妇孕前肥胖、产前肥胖均会延长剖宫产麻醉、手术时间,增加术后发病率,在今后的临床工作中应给予重视,积极采取有效应对措施,加强宣教,控制孕期体重,降低剖宫产率,减少母婴并发症,改善妊娠结局。

Objective To analyze the relationship between obesity of pregnant women and complications during and after cesarean section,in order to provide a reference for the prevention and treatment of cesarean section complications.Methods From May 2018 to May 2019,368 pregnant women undergoing cesarean section were selected as the research objects.They were divided into three groups according to the body mass index(BMI).The pre-pregnancy BMI≥25 kg/m2125 cases were set as pre-pregnancy obesity group,119 cases with BMI>28 kg/m2 before childbirth were set as antenatal obesity group,and 124 cases with BMI before pregnancy 17-24 kg/m2 were set as normal control group.The anesthesia time,operation time,time from laparotomy to delivery of the fetal head,intraoperative blood loss,postoperative wound healing,hospitalization time,and incidence of incision fat liquefaction were compared among the three groups.Results The pre-pregnancy obesity group anesthesia time,the time from laparotomy to delivery of the fetal head,and the operation time were slightly longer than the normal control group time,but the difference was not statistically significant(P>0.05);the prenatal obesity group anesthesia time,the time from laparotomy to delivery of the fetal head the time and operation time were longer than those in the normal control group.The incidence of postoperative complications,thrombotic diseases,and fat liquefaction of abdominal wall incision were higher than those of the control group(P<0.05);the intraoperative bleeding was higher in the pregnant and prenatal obesity groups The normal control group increased,and the incidence of thrombotic diseases was higher than that of the control group,the difference was not statistically significant(P>0.05);the incidence of postoperative complications and incision fat liquefaction in the pre-pregnancy obesity group was higher than that of the control group(P<0.05);the postoperative hospital stay in the pregnancy and prenatal obesity group was longer than that in the control group(P<0.05).Conclusion Pre-pregnancy obesity and prenatal obesity would prolong the anesthesia and operation time of cesarean section and increase the postoperative morbidity.In future clinical work,attention should be paid to actively adopt effective countermeasures,strengthen publicity and education,control weight during pregnancy,and reduce cesarean section.Uterine birth rate,reduce maternal and infant complications,and improve pregnancy outcome.