中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2015年
5期
323-328
,共6页
陈奕%邹丽颖%李光辉%阮炎%王欣%张为远
陳奕%鄒麗穎%李光輝%阮炎%王訢%張為遠
진혁%추려영%리광휘%원염%왕흔%장위원
婴儿,出生时低体重%剖宫产术%妊娠结局
嬰兒,齣生時低體重%剖宮產術%妊娠結跼
영인,출생시저체중%부궁산술%임신결국
Infant,low birth weight%Cesarean section%Pregnancy outcome
目的：调查分析我国低出生体质量儿的分娩方式及围产结局，探讨其适宜的分娩方式及适时终止妊娠的时机。方法对2011年1月1日至12月31日我国东北、西北、华北、华中、华东、华南、西南地区，包括首都医科大学附属北京妇产医院在内的39家医院分娩的103678例孕产妇的有效临床资料进行回顾性分析。结果（1）新生儿平均出生体质量为（3263±540）g，低出生体重儿7474例，发生率为7.209％（7474/103678）。其中足月低出生体质量儿2214例，发生率为2.328%（2214/95116）；早产低出生体质量儿5260例，发生率为61.434%（5260/8562例）。（2）自28孕周起至36孕周，剖宫产率随孕周的增加而上升。足月低出生体质量儿的剖宫产率为61.14％（1139/1863），高于出生正常体质量儿的52.947％（45108/85195），两者比较，差异有统计学意义（P<0.01）。（3）低出生体质量儿的剖宫产指征构成比显示，10.73％（443/4128）为社会因素，48.91％（2019/4128）为母体因素；出生正常体质量儿的剖宫产指征构成比的社会因素、母体因素分别为27.70％（12495/45108）、38.60％（17412/45108）。两者比较，差异均有统计学意义（P<0.01）。（4）足月低出生体质量儿的急诊剖宫产率为41.09%（468/1139），比出生正常体质量儿急诊剖宫产率的31.09%（14024/45108）明显上升，差异有统计学意义（P<0.01）。（5）足月低出生体质量儿的死产率、新生儿窒息率及新生儿死亡率分别为2.36％（44/1863）、6.12％（114/1863）和3.17％（59/1863）；出生正常体质量儿则分别为0.11％（94/85195）、1.41％（1201/85195）和0.14％（119/85195）；分别比较，差异均有统计学意义（P<0.01）。（6）以剖宫产术分娩的低出生体质量儿死产率（0.53%）及新生儿死亡率（0.97%）明显低于阴道分娩者（分别为5.25%、6.63%）；尤其是在孕28～33周＋6的剖宫产术分娩者新生儿窒息率（17.95%）及新生儿并发症发生率（3.61%）也明显低于阴道分娩者（分别为30.09%、6.62%）。（7）随孕周增加，不同分娩孕周的低出生体质量儿新生儿窒息率和死产率有所减少，在28~29孕周时新生儿窒息率（39.22%）和死产率（23.28%）最高，至34孕周后则明显下降（分别为9.08%及2.88%）。结论低出生体质量儿是导致围产儿死亡等不良围产结局和剖宫产率增加的原因之一；减少低出生体质量儿的发生，应根据孕周及胎儿情况行个体化分析，尽可能使孕周延长至孕34周后终止妊娠；分娩方式的选择应依据孕妇及胎儿的具体病情而定，这样才能明显提高新生儿存活率。
目的：調查分析我國低齣生體質量兒的分娩方式及圍產結跼，探討其適宜的分娩方式及適時終止妊娠的時機。方法對2011年1月1日至12月31日我國東北、西北、華北、華中、華東、華南、西南地區，包括首都醫科大學附屬北京婦產醫院在內的39傢醫院分娩的103678例孕產婦的有效臨床資料進行迴顧性分析。結果（1）新生兒平均齣生體質量為（3263±540）g，低齣生體重兒7474例，髮生率為7.209％（7474/103678）。其中足月低齣生體質量兒2214例，髮生率為2.328%（2214/95116）；早產低齣生體質量兒5260例，髮生率為61.434%（5260/8562例）。（2）自28孕週起至36孕週，剖宮產率隨孕週的增加而上升。足月低齣生體質量兒的剖宮產率為61.14％（1139/1863），高于齣生正常體質量兒的52.947％（45108/85195），兩者比較，差異有統計學意義（P<0.01）。（3）低齣生體質量兒的剖宮產指徵構成比顯示，10.73％（443/4128）為社會因素，48.91％（2019/4128）為母體因素；齣生正常體質量兒的剖宮產指徵構成比的社會因素、母體因素分彆為27.70％（12495/45108）、38.60％（17412/45108）。兩者比較，差異均有統計學意義（P<0.01）。（4）足月低齣生體質量兒的急診剖宮產率為41.09%（468/1139），比齣生正常體質量兒急診剖宮產率的31.09%（14024/45108）明顯上升，差異有統計學意義（P<0.01）。（5）足月低齣生體質量兒的死產率、新生兒窒息率及新生兒死亡率分彆為2.36％（44/1863）、6.12％（114/1863）和3.17％（59/1863）；齣生正常體質量兒則分彆為0.11％（94/85195）、1.41％（1201/85195）和0.14％（119/85195）；分彆比較，差異均有統計學意義（P<0.01）。（6）以剖宮產術分娩的低齣生體質量兒死產率（0.53%）及新生兒死亡率（0.97%）明顯低于陰道分娩者（分彆為5.25%、6.63%）；尤其是在孕28～33週＋6的剖宮產術分娩者新生兒窒息率（17.95%）及新生兒併髮癥髮生率（3.61%）也明顯低于陰道分娩者（分彆為30.09%、6.62%）。（7）隨孕週增加，不同分娩孕週的低齣生體質量兒新生兒窒息率和死產率有所減少，在28~29孕週時新生兒窒息率（39.22%）和死產率（23.28%）最高，至34孕週後則明顯下降（分彆為9.08%及2.88%）。結論低齣生體質量兒是導緻圍產兒死亡等不良圍產結跼和剖宮產率增加的原因之一；減少低齣生體質量兒的髮生，應根據孕週及胎兒情況行箇體化分析，儘可能使孕週延長至孕34週後終止妊娠；分娩方式的選擇應依據孕婦及胎兒的具體病情而定，這樣纔能明顯提高新生兒存活率。
목적：조사분석아국저출생체질량인적분면방식급위산결국，탐토기괄의적분면방식급괄시종지임신적시궤。방법대2011년1월1일지12월31일아국동북、서북、화북、화중、화동、화남、서남지구，포괄수도의과대학부속북경부산의원재내적39가의원분면적103678례잉산부적유효림상자료진행회고성분석。결과（1）신생인평균출생체질량위（3263±540）g，저출생체중인7474례，발생솔위7.209％（7474/103678）。기중족월저출생체질량인2214례，발생솔위2.328%（2214/95116）；조산저출생체질량인5260례，발생솔위61.434%（5260/8562례）。（2）자28잉주기지36잉주，부궁산솔수잉주적증가이상승。족월저출생체질량인적부궁산솔위61.14％（1139/1863），고우출생정상체질량인적52.947％（45108/85195），량자비교，차이유통계학의의（P<0.01）。（3）저출생체질량인적부궁산지정구성비현시，10.73％（443/4128）위사회인소，48.91％（2019/4128）위모체인소；출생정상체질량인적부궁산지정구성비적사회인소、모체인소분별위27.70％（12495/45108）、38.60％（17412/45108）。량자비교，차이균유통계학의의（P<0.01）。（4）족월저출생체질량인적급진부궁산솔위41.09%（468/1139），비출생정상체질량인급진부궁산솔적31.09%（14024/45108）명현상승，차이유통계학의의（P<0.01）。（5）족월저출생체질량인적사산솔、신생인질식솔급신생인사망솔분별위2.36％（44/1863）、6.12％（114/1863）화3.17％（59/1863）；출생정상체질량인칙분별위0.11％（94/85195）、1.41％（1201/85195）화0.14％（119/85195）；분별비교，차이균유통계학의의（P<0.01）。（6）이부궁산술분면적저출생체질량인사산솔（0.53%）급신생인사망솔（0.97%）명현저우음도분면자（분별위5.25%、6.63%）；우기시재잉28～33주＋6적부궁산술분면자신생인질식솔（17.95%）급신생인병발증발생솔（3.61%）야명현저우음도분면자（분별위30.09%、6.62%）。（7）수잉주증가，불동분면잉주적저출생체질량인신생인질식솔화사산솔유소감소，재28~29잉주시신생인질식솔（39.22%）화사산솔（23.28%）최고，지34잉주후칙명현하강（분별위9.08%급2.88%）。결론저출생체질량인시도치위산인사망등불량위산결국화부궁산솔증가적원인지일；감소저출생체질량인적발생，응근거잉주급태인정황행개체화분석，진가능사잉주연장지잉34주후종지임신；분면방식적선택응의거잉부급태인적구체병정이정，저양재능명현제고신생인존활솔。
Objectives To investigate the delivery mode and perinatal outcomes of low birth weight infants in mainland China, and to explore the appropriate delivery mode and timing of delivery. Methods Clinical data of 103 678 babies delivered from Jan 1st to Dec 31th, 2011 in 39 hospitals in mainland China were analyzed retrospectively. The 39 hospitals located in 7 administrative regions, including Northeast, Northwest, North, Central, East, South and Southwest China. Result (1) The average birth weight of the newborns was (3 263 ± 540) g. Among them, 7 474 cases were diagnosed low birth weight infants, with the incidence of 7.209%(7 474/103 678). There were 2.328%(2 214/95 116 ) full-term low birth weight infants and 61.434% (5 260/8 562 ) preterm low birth weight infants. (2) From week 28 to week 36, the cesarean section rate of low birth weight infants increased with the increasing of gestational weeks. The cesarean section rate of full-term low birth weight infants were 61.14%(1 139/1 863) , which was higher than that of normal birth weight infants (52.947%, 45 108/85 195). The differences were statistically significant (P<0.01). (3) The constitution of the indication of cesarean section showed that social factor and maternal factor were 10.73%(443/4 128) and 48.91%(2 019/4 128) for low birth weight infants, respectively. While for the normal birth weight infants, they were 27.70%(12 495/45 108) and 38.60%(17 412/45 108), respectively. There was statistically significant difference(P<0.01). (4) The emergency cesarean section rate of full-term low birth weight infants was 41.09%(468/1 139), which was higher than that of normal birth weight infants (31.09%, 14 024/45 108). The difference was statistically significant (P<0.01). (5) The rates of stillbirth, neonatal asphyxia and the mortality of full-term low birth weight infants were 2.36%(44/1 863), 6.12%(114/1 863), and 3.17%(59/1 863), respectively. Those of normal birth weight infants were 0.11%(94/85 195), 1.41%(1 201/85 195), and 0.14%(119/85 195), respectively. The differences were statistically significant (P<0.01). (6) The stillbirth rate and mortality of low birth weight infants born by cesarean delivery were significantly lower than those born by vaginal delivery. The rate of neonatal asphyxia (17.95%) and other morbidity (3.61%) among low birth weight infants born by cesarean section in week 28 to week 33+6 were significantly lower than those born by vaginal delivery (30.09%, 6.62%, respectively). (7) With the increase of gestational age, the incidence of neonatal asphyxia and stillbirth decreased. The incidence of neonatal asphyxia(39.22%) and stillbirth(23.28%) was most seen in 28 to 29 gestational weeks, which decreased to 9.08% and 2.88% in 34 gestation weeks. Conclusions Low birth weight is one of the leading causes of adverse perinatal outcomes and cesarean section. To decrease the incidence of low birth weight, individualized management should be performed according to the gestational age and fetal condition. Extending the gestational age to at least 34 weeks may avoid iatrogenic preterm labor and improve the neonatal survival rate.
