分娩性臂丛神经麻痹发病危险因素的探讨
분면성비총신경마비발병위험인소적탐토
Case-control study of risk factors of obstetrical brachial plexus palsy
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2011年 11期 840-844 ,共5页

    杨素婷%张向丽

    양소정%장향려

    臂丛神经病%分娩并发症%危险因素 臂叢神經病%分娩併髮癥%危險因素
    비총신경병%분면병발증%위험인소
    Brachial plexus neuropathies%Obstetric labor complications%Risk factors
    目的 探讨分娩性臂丛神经麻痹(OBPP)的发病危险因素.方法 收集1997年1月至2009年12月山东省医疗事故鉴定办公室进行医疗鉴定并已诊断为OBPP的46例患者为OBPP组,按照1:3的匹配方式随机选取同医院、同时期、同性别的正常分娩138例新生儿作为对照组.采用回顾性病例对照研究的方法,对两组新生儿情况、产妇情况、分娩过程及助产士工作年限等因素进行单因素及多因素logistic回归分析.结果 (1)两组产妇骨盆外测量均在正常值范围,两组新生儿均为单胎头位并经阴道分娩.OBPP组均为单侧臂丛神经损伤,其中左侧22例,右侧24例;全臂型17例,上臂型26例,前臂型3例.两组产妇年龄、孕产次及分娩孕龄比较,差异均有统计学意义(P＜0.05).(2)OBPP组产前体质指数(BMI)、宫高、腹围分别为(29.5±2.4) kg/m2、(34.9±2.4)及(105±6) cm,对照组分别为(26.1±2.5)kg/m2、(33.7±2.2)及(99±5) cm,两组比较,差异有统计学意义(P＜0.05).OBPP组新生儿平均出生体质量[(4390±489)g]明显高于对照组[(3404±360)g],两组比较,差异有统计学意义(P＜0.01).OBPP组助产士工作年限[(5.2±2.3)年]明显低于对照组[(8.9±5.4)年],两组比较,差异有统计学意义(P＜0.01).(3)OBPP组与对照组应用器械助产率分别为28.3％及3.6％,宫缩乏力发生率分别为28.3％及6.5％,第二产程延长发生率分别为8.7％及0.7％,胎方位异常发生率分别为10.9％及2.9％.OBPP组以上各指标均高于对照组,两组比较,差异均有统计学意义(P＜0.05).(4)条件logistic回归单因素分析发现,两组产妇年龄、产前BMI、宫高、腹围、新生儿出生体质量、孕次、第二产程时间、分娩助产、胎位异常、宫缩乏力及助产士工作年限比较,差异均有统计学意义(P均＜0.05).其中,助产士工作年限为保护性因素.(5)将上述各相关指标作为变量,选择逐步回归法进行多因素logistic回归分析,选人界值均为0.10,结果显示,孕妇产前BMI和新生儿出生体质量与OBPP发生有关联(P＜0.10),OR值分别为1.733和1.004.孕妇产前BMI OR值大于新生儿出生体质量OR值,孕妇产前BMI意义大于新生儿出生体质量.结论 孕妇产前BMI是OBPP发病的最重要危险因素,其次,另一个高危因素是新生儿出生体质量.助产士工作年限较长是其保护性因素.
    목적 탐토분면성비총신경마비(OBPP)적발병위험인소.방법 수집1997년1월지2009년12월산동성의료사고감정판공실진행의료감정병이진단위OBPP적46례환자위OBPP조,안조1:3적필배방식수궤선취동의원、동시기、동성별적정상분면138례신생인작위대조조.채용회고성병례대조연구적방법,대량조신생인정황、산부정황、분면과정급조산사공작년한등인소진행단인소급다인소logistic회귀분석.결과 (1)량조산부골분외측량균재정상치범위,량조신생인균위단태두위병경음도분면.OBPP조균위단측비총신경손상,기중좌측22례,우측24례;전비형17례,상비형26례,전비형3례.량조산부년령、잉산차급분면잉령비교,차이균유통계학의의(P＜0.05).(2)OBPP조산전체질지수(BMI)、궁고、복위분별위(29.5±2.4) kg/m2、(34.9±2.4)급(105±6) cm,대조조분별위(26.1±2.5)kg/m2、(33.7±2.2)급(99±5) cm,량조비교,차이유통계학의의(P＜0.05).OBPP조신생인평균출생체질량[(4390±489)g]명현고우대조조[(3404±360)g],량조비교,차이유통계학의의(P＜0.01).OBPP조조산사공작년한[(5.2±2.3)년]명현저우대조조[(8.9±5.4)년],량조비교,차이유통계학의의(P＜0.01).(3)OBPP조여대조조응용기계조산솔분별위28.3％급3.6％,궁축핍력발생솔분별위28.3％급6.5％,제이산정연장발생솔분별위8.7％급0.7％,태방위이상발생솔분별위10.9％급2.9％.OBPP조이상각지표균고우대조조,량조비교,차이균유통계학의의(P＜0.05).(4)조건logistic회귀단인소분석발현,량조산부년령、산전BMI、궁고、복위、신생인출생체질량、잉차、제이산정시간、분면조산、태위이상、궁축핍력급조산사공작년한비교,차이균유통계학의의(P균＜0.05).기중,조산사공작년한위보호성인소.(5)장상술각상관지표작위변량,선택축보회귀법진행다인소logistic회귀분석,선인계치균위0.10,결과현시,잉부산전BMI화신생인출생체질량여OBPP발생유관련(P＜0.10),OR치분별위1.733화1.004.잉부산전BMI OR치대우신생인출생체질량OR치,잉부산전BMI의의대우신생인출생체질량.결론 잉부산전BMI시OBPP발병적최중요위험인소,기차,령일개고위인소시신생인출생체질량.조산사공작년한교장시기보호성인소.
    Objective To study the risk factors of obstetrical brachial plexus palsy (OBPP).Methods Forty-six newborn infants with OBPP were recruited between January 1997 and December 2009 from Technical Appraisement Center for Medical Malpractice of Shandong province as OBPP group.In the control group,138 newborn infants delivered in the same time,same hospital and same gender were collected,with a ratio of 1:3.All the cases were analyzed retrospectively.The newborn,maternal,childbirth data and working experience of midwives were analyzed by univariate and multivariate logistic regression analysis.Results ( 1 ) External pelvimetries of the two groups were normal.All were singleton newborns by vaginal deliveries with cephalic presentation.Twenty-two newborns had left unilateral palsies,and the other 24 had right unilateral palsies.The numbers of the whole,upper and fore arm type were 17,26 and 3,respectively.The maternal age,gravidity,parity and gestational weeks were higher in OBPP group than in the control group ( P ＜ 0.05 ).( 2 ) The maternal antepartum body mass index ( BMI ) [ ( 29.5 ± 2.4 ) kg/m2 ],height of the uterus [ (34.9 ± 2.4) cm ] and abdominal circumference [ ( 105 ± 6) cm ] in OBPP group were higher than those in the control group [ ( 26.1 ± 2.5 ) kg/m2,( 33.7 ± 2.2 ) cm and ( 99 ± 5 ) cm,respectively ] ( P ＜ 0.05 ).The newborn birth weight in OBPP group [ ( 4390 ± 489 ) g ] was significantly higher than the control group [ ( 3404 ± 360 ) g] ( P ＜ 0.01 ).The working experience of midwives in OBPP group [ ( 5.2 ± 2.3 ) years ] was less than the control group [ ( 8.9 ± 5.4) years ] ( P ＜ 0.01 ).(3) There was a higher proportion of instrumental delivery ( 28.3％ vs.3.6％ ),uterine atony (28.3％ vs.6.5％ ),prolonged second stage(8.7％ vs.0.7％ ) and fetal malposition( 10.9％ vs.2.9％ ) in the OBPP group than in the control group ( P ＜ 0.05 ).(4) Univariate logistic analysis showed that the P values of maternal age,antepartum BMI,height of uterus,abdominal circumference,newborn birth weight,gravidity,second stage duration,instrumental delivery,fetal malposition,uterine atony and working experience of midwives were all less than 0.10.And the working experience of midwives was a protective factor.(5)The factors listed above were taken as variables,selected stepwise regression for multivariate logistic regression analysis.Boundary value was 0.10.It showed that the antepartum BMI ( OR =1.733 ) and newborn birth weight ( OR =1.004 ) were related to OBPP ( P ＜ 0.10 ).The significance of maternal antepartum BMI was higher than birth weight.Conclusions The maternal antepartum BMI is the most important risk factor for OBPP,and the newborn birth weight is the other risk factor.The working experience of midwives is a protective factor.
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