湖北科技学院学报（医学版）
湖北科技學院學報（醫學版）
호북과기학원학보（의학판）
JOURNAL OF XIANNING UNIVERSITY (MEDICAL SCIENCES)
2014年
1期
20-23
,共4页
沈素娟%董云%郑帅英%杨丽
瀋素娟%董雲%鄭帥英%楊麗
침소연%동운%정수영%양려
剖宫产%再次妊娠%阴道试产%分娩方式%预测%Fisher判别
剖宮產%再次妊娠%陰道試產%分娩方式%預測%Fisher判彆
부궁산%재차임신%음도시산%분면방식%예측%Fisher판별
Cesarean section%Pregnancy%Vaginal delivery%Delivery mode%Prediction%Fisher discriminant
目的：应用Fisher判别法归类剖宫产术后再次妊娠的分娩方式，为剖宫产史（ PCS）孕妇分娩方式的选择提供参考。方法以愿意阴道试产的216例 PCS 孕妇为研究对象，采集年龄、职业、临产前体重指数（ BMI）、距前次剖宫产时间、妊娠并发症、超声测量胎儿腹围、胎儿双顶径、子宫下段厚度、胎儿性别，记录分娩中Bishop宫颈成熟评分、宫缩剂应用情况等。结果①分娩方式：阴道自然分娩成功66例，阴道助产分娩成功58例，剖宫产分娩92例。②单因素分析显示：3种分娩方式在职业、临产前BMI、胎儿腹围、双顶径、宫缩剂应用、距前次剖宫产时间、子宫下段厚度和Bishop评分方面差异有统计学有意义，P＜0．05。③逐步法Fisher判别入选判别函数的因素是胎儿腹围（ X1）、子宫下段厚度（ X2）、Bishop评分（ X3）和应用宫缩剂（ X4）。 Fisher判别函数：Function 1＝-0．101X1＋2．202X2＋0．649X3＋0．289X4-9．243；Function 2＝0．258X1-0．156X2＋0.593X3＋0．409X4-14．384。④函数预测阴道顺产、阴道助产和剖宫产的敏感性分别是80．30％、56．90％和78．26％，总体符合率为73．15％。结论胎儿腹围、子宫下段厚度、Bishop评分和应用宫缩剂是影响PCS孕妇阴道分娩成败的重要因素。以此4项指标建立的Fisher判别函数可为PCS孕妇分娩方式的选择提供中等强度诊断效能。
目的：應用Fisher判彆法歸類剖宮產術後再次妊娠的分娩方式，為剖宮產史（ PCS）孕婦分娩方式的選擇提供參攷。方法以願意陰道試產的216例 PCS 孕婦為研究對象，採集年齡、職業、臨產前體重指數（ BMI）、距前次剖宮產時間、妊娠併髮癥、超聲測量胎兒腹圍、胎兒雙頂徑、子宮下段厚度、胎兒性彆，記錄分娩中Bishop宮頸成熟評分、宮縮劑應用情況等。結果①分娩方式：陰道自然分娩成功66例，陰道助產分娩成功58例，剖宮產分娩92例。②單因素分析顯示：3種分娩方式在職業、臨產前BMI、胎兒腹圍、雙頂徑、宮縮劑應用、距前次剖宮產時間、子宮下段厚度和Bishop評分方麵差異有統計學有意義，P＜0．05。③逐步法Fisher判彆入選判彆函數的因素是胎兒腹圍（ X1）、子宮下段厚度（ X2）、Bishop評分（ X3）和應用宮縮劑（ X4）。 Fisher判彆函數：Function 1＝-0．101X1＋2．202X2＋0．649X3＋0．289X4-9．243；Function 2＝0．258X1-0．156X2＋0.593X3＋0．409X4-14．384。④函數預測陰道順產、陰道助產和剖宮產的敏感性分彆是80．30％、56．90％和78．26％，總體符閤率為73．15％。結論胎兒腹圍、子宮下段厚度、Bishop評分和應用宮縮劑是影響PCS孕婦陰道分娩成敗的重要因素。以此4項指標建立的Fisher判彆函數可為PCS孕婦分娩方式的選擇提供中等彊度診斷效能。
목적：응용Fisher판별법귀류부궁산술후재차임신적분면방식，위부궁산사（ PCS）잉부분면방식적선택제공삼고。방법이원의음도시산적216례 PCS 잉부위연구대상，채집년령、직업、임산전체중지수（ BMI）、거전차부궁산시간、임신병발증、초성측량태인복위、태인쌍정경、자궁하단후도、태인성별，기록분면중Bishop궁경성숙평분、궁축제응용정황등。결과①분면방식：음도자연분면성공66례，음도조산분면성공58례，부궁산분면92례。②단인소분석현시：3충분면방식재직업、임산전BMI、태인복위、쌍정경、궁축제응용、거전차부궁산시간、자궁하단후도화Bishop평분방면차이유통계학유의의，P＜0．05。③축보법Fisher판별입선판별함수적인소시태인복위（ X1）、자궁하단후도（ X2）、Bishop평분（ X3）화응용궁축제（ X4）。 Fisher판별함수：Function 1＝-0．101X1＋2．202X2＋0．649X3＋0．289X4-9．243；Function 2＝0．258X1-0．156X2＋0.593X3＋0．409X4-14．384。④함수예측음도순산、음도조산화부궁산적민감성분별시80．30％、56．90％화78．26％，총체부합솔위73．15％。결론태인복위、자궁하단후도、Bishop평분화응용궁축제시영향PCS잉부음도분면성패적중요인소。이차4항지표건립적Fisher판별함수가위PCS잉부분면방식적선택제공중등강도진단효능。
Objective To classify the pregnancies after cesarean section by using Fisher discriminant in order to provide a reference mode of delivery in pregnant women with the history of cesarean section ( PCS ) . Methods 216 cases of PCS pregnant women with vaginal delivery were applied in this study .Age, occupation , labor before the body mass index ( BMI) , the time from a previous cesarean section , complications of pregnan-cy, fetal abdominal circumference , fetal biparietal diameter , the lower uterine segment thickness , the sex of a fetus, the Bishop cervical ripening score , and the application of contraction agent were collected .Results ①The mode of delivery:Vaginal delivery was successful in 66 cases.Vaginal midwifery delivery was successful in 58 cases.Cesarean section delivery was successful in 92 cases.②Single factor analysis showed:The three kinds of mode of delivery has statistically significantat in occupation , preclinical BMI , fetal abdominal circum-ference , biparietal diameter , application , tocolytic agents from the previous cesarean section time , lower uter-ine segment thickness and Bishop score , P<0.05.③The selected discriminant factors were the fetal abdomi-nal circumference ( X1 ) , the lower uterine segment thickness ( X2 ) , Bishop score ( X3 ) and the application of of oxytocin ( X4 ) by stepwise Fisher discriminant function .Fisher discriminant function: Function 1 =-0. 101X1+2.202X2 +0.649X3 +0.289X4 -9.243;Function 2=0.258X1 -0.156X2 +0.593X3 +0.409X4 -14 .384 .④The sensitivity of spontaneous vaginal delivery , vaginal delivery and cesarean section is respectively 80.30%, 56.90%and 78.26% by Function prediction.Overall compliance rate was 73.15%.Conclusion Fetal abdominal circumference , the lower uterine segment thickness , Bishop score and application of tocolytic agents are the main factors affecting the success of PCS pregnant women with vaginal delivery .It can provide a moderate diagnostic efficacy for PCS pregnant women with vaginal delivery based on the four indexes of Fisher discriminant function .
