5分钟紧急剖宫产对改善急诊危重孕产妇母婴结局的临床价值

Clinical value of emergency 5-minute cesarean section in improving maternal and infantile outcomes of critical pregnant women

目的观察5分钟紧急剖宫产对改善急诊危重孕产妇母婴结局的临床效果。方法收集2017年1月至2019年12月在安徽省妇幼保健院产科收治的60例急诊危重孕产妇,根据急诊剖宫产流程分为观察组(n=30)和对照组(n=30),对照组在常规紧急剖宫产流程下进行手术,观察组行5分钟紧急剖宫产,分析比较两组产妇的手术情况及并发症、决定手术到胎儿娩出时间间隔(DDI)以及母婴不良妊娠结局的发生情况。结果观察组DDI为(7.89±4.03)min,明显较对照组的(29.05±13.90)min缩短,t=8.01,P<0.01;观察组从决定手术至进手术室时间、进手术室至手术开始时间均较对照组明显缩短,差异有统计学意义(t=6.44,P<0.01;t=18.47,P<0.01);观察组从手术开始到胎儿娩出时间和对照组无统计学差异(t=1.59,P=0.12);两组产妇住院时间和术中出血量之间均无统计学差异(t=0.32,P=0.75;t=1.00,P=0.32);观察组产妇术后并发症的发生率(6.67%)较对照组(26.67%)低(χ^(2)=4.32,P=0.04);观察组不良妊娠结局发生率(23.33%)低于对照组(40.00%),差异有统计学意义(χ^(2)=4.59,P=0.03),其中观察组产妇不良妊娠结局发生率(10.00%)与对照组(23.33%)之间无统计学差异(χ^(2)=1.92,P=0.17);观察组胎儿不良妊娠结局的发生率(13.33%)较对照组(36.67%)低,χ^(2)=4.36,P=0.04。结论5分钟紧急剖宫产可缩短急诊危重孕产妇剖宫产DDI,并改善急诊危重孕产妇母婴结局。

Objective To observe clinical effect of 5-minute emergency cesarean section in improving maternal and infantile outcomes of emergency critical pregnant women.Methods A total of 60 emergency critical pregnant women who admitted to Department of Obstetrics,Anhui Provincial Maternity and Child Health Hospital from January 2017 to December 2019 were selected as observation subjects.According to emergency cesarean section process,the critical pregnant women were divided into observation group(n=30)and control group(n=30).The pregnant women in the control group underwent conventional emergency cesarean section,and those pregnant women in the observation group underwent 5-minute emergency cesarean section.Surgical conditions and complications of the pregant women in the two groups,time interval from operation decision-making to expulsion of the fetus(decision to delivery interval,DDI),and incidence of adverse pregnancy outcomes were analyzed and compared.Results The DDI in the observation group(7.89±4.03 min)was significantly shorter than that in the control group(29.05±13.90 min),the difference was statistically significant(t=8.01,P<0.01).The time from decision-making of the operation to entering operating room and the time from entering operating room to beginning of the operation in the observation group were significantly shorter than those in the control group(t=6.44,P<0.01;t=18.47,P<0.01).There was no significant difference in the time from beginning of operation to fetus delivery between the observation group and the control group(t=1.59,P=0.12).There were no significant differences in hospital stay and intraoperative bleeding between the two groups(t=0.32,P=0.75;t=1.00,P=0.32).The incidence of postoperative complications in the observation group(6.67%)was lower than that in the control group(26.67%)(χ^(2)=4.32,P=0.04).The total incidence of adverse pregnancy outcomes in the observation group(23.33%)was lower than that in the control group(40.00%),and the difference was statistically significant(χ^(2)=4.59,P=0.03).There was no significant difference in incidence of adverse maternal outcomes between the observation group(10.00%)and the control group(23.33%)(χ^(2)=1.92,P=0.17),while the incidence of adverse fetal outcomes in the observation group(13.33%)was lower than that in the control group(36.67%)(χ^(2)=4.36,P=0.04).Conclusions 5-minute emergency cesarean section can shorten the DDI of emergency critical pregnant women and improve the maternal and infantile outcomes.