CAJ | 학술논문

目的：探讨剖宫产分娩与新生儿疾病发生是否存在关联，为预防新生儿疾病的发生和降低剖宫产率提供依据。方法通过病历管理系统，选择2004年1月—2013年12月在温州医科大学附属第一医院产科住院分娩的产妇及其新生儿为研究对象，采用病例对照的研究方法，以患有某种新生儿疾病的新生儿为病例组，不患有该种疾病的新生儿为对照组，比较两组剖宫产率是否存在差异。分析时采用多因素 Logistic 回归分析调整产妇年龄、新生儿性别、剖宫产指征等因素对两者关联的影响。结果59.3％（2035/3432）的产妇分娩方式为剖宫产，54.7％（1876例）的产妇具有剖宫产指征；40.7％（1397例）的产妇为阴道分娩。阴道分娩者和剖宫产者年龄、入院待产时间、是否实施抢救、剖宫产指征、住院时间、分娩总费用、分娩护理费用比较，差异均有统计学意义（P ﹤0.01）；两者新生儿性别比较，差异无统计学意义（P ＝0.05）。Logistic 回归分析结果显示，新生儿肺部疾病〔OR ＝1.48，95％ CI（1.03，2.11），P ＝0.03〕、新生儿窒息〔OR ＝0.37，95％ CI（0.29，0.47），P ﹤0.01〕、低体质量儿〔 OR ＝1.56，95％ CI （1.09，2.23），P ＝0.02〕、早产儿〔OR ＝2.21，95％ CI（1.97，2.61），P ﹤0.01〕和低体质量早产儿〔 OR ＝3.00，95％ CI（1.98，4.56），P ﹤0.01〕与剖宫产分娩存在关联，而新生儿消化系统疾病〔 OR ＝1.64，95％ CI（0.83，3.24），P ＝0.16〕和新生儿败血症〔OR ＝0.69，95％ CI（0.91，3.69），P ＝0.28〕与剖宫产分娩无关。结论剖宫产分娩可能增加新生儿罹患呼吸系统疾病的风险，降低新生儿窒息的发生，而与消化系统疾病发生无关。低体质量儿、早产儿和低体质量早产儿更容易选择剖宫产，增加剖宫产率。
목적：탐토부궁산분면여신생인질병발생시부존재관련，위예방신생인질병적발생화강저부궁산솔제공의거。방법통과병력관리계통，선택2004년1월—2013년12월재온주의과대학부속제일의원산과주원분면적산부급기신생인위연구대상，채용병례대조적연구방법，이환유모충신생인질병적신생인위병례조，불환유해충질병적신생인위대조조，비교량조부궁산솔시부존재차이。분석시채용다인소 Logistic 회귀분석조정산부년령、신생인성별、부궁산지정등인소대량자관련적영향。결과59.3％（2035/3432）적산부분면방식위부궁산，54.7％（1876례）적산부구유부궁산지정；40.7％（1397례）적산부위음도분면。음도분면자화부궁산자년령、입원대산시간、시부실시창구、부궁산지정、주원시간、분면총비용、분면호리비용비교，차이균유통계학의의（P ﹤0.01）；량자신생인성별비교，차이무통계학의의（P ＝0.05）。Logistic 회귀분석결과현시，신생인폐부질병〔OR ＝1.48，95％ CI（1.03，2.11），P ＝0.03〕、신생인질식〔OR ＝0.37，95％ CI（0.29，0.47），P ﹤0.01〕、저체질량인〔 OR ＝1.56，95％ CI （1.09，2.23），P ＝0.02〕、조산인〔OR ＝2.21，95％ CI（1.97，2.61），P ﹤0.01〕화저체질량조산인〔 OR ＝3.00，95％ CI（1.98，4.56），P ﹤0.01〕여부궁산분면존재관련，이신생인소화계통질병〔 OR ＝1.64，95％ CI（0.83，3.24），P ＝0.16〕화신생인패혈증〔OR ＝0.69，95％ CI（0.91，3.69），P ＝0.28〕여부궁산분면무관。결론부궁산분면가능증가신생인리환호흡계통질병적풍험，강저신생인질식적발생，이여소화계통질병발생무관。저체질량인、조산인화저체질량조산인경용역선택부궁산，증가부궁산솔。
Objective To investigate whether correlation exists between cesarean section and neonatal diseases,in order to provide references for the prevention of neonatal diseases and the reduction of cesarean section rate. Methods With the aid of case management system,we enrolled the lying - in women who had child delivery in the First Affiliated Hospital of Wenzhou Medical University from January 2004 to December 2013 and the newborns. Using case - control research method,we assigned newborns that had neonatal disease as case group and newborns that didn’t have any neonatal disease as control group. Comparison was made in cesarean section rate between the two groups. Multivariate Logistic analysis was made to adjust the influence of lying - in women’ s age,newborns’gender and cesarean section indication on the correlation between cesarean section and neonatal diseases. Results The cesarean section rate was 59. 3% (2 035 / 3 432),54. 7% (1 876)had cesarean section indication;the ratio of vaginal delivery was 40. 7% (1 397). The subjects undergoing vaginal delivery and the subjects undergoing cesarean section were significantly different(P ﹤ 0. 01)in age,expectancy time,receiving salvage or not,cesarean section indication,hospitalization time,the total cost of delivery and the cost of delivery nursing and were not significantly different in newborns’gender( P = 0. 05). Logistic regression analysis showed that pulmonary diseases in newborns〔 OR =1. 48,95% CI(1. 03,2. 11),P = 0. 03〕,neonatal asphyxia〔OR = 0. 37,95% CI(0. 29,0. 47),P ﹤ 0. 01〕,low birth weight〔OR = 1. 56,95% CI(1. 09,2. 23),P = 0. 02〕,premature infants〔 OR = 2. 21,95% CI(1. 97,2. 61),P ﹤0. 01〕and premature infants with low birth weight〔 OR = 3. 00,95% CI(1. 98,4. 56),P ﹤ 0. 01〕had correlation with cesarean section,while neonatal digestive system diseases〔 OR = 1. 64,95% CI(0. 83,3. 24),P = 0. 16〕 and neonatal septicemia〔OR = 0. 69,95% CI(0. 91,3. 69),P = 0. 28〕had no correlation with cesarean section. Conclusion Cesarean section may increase the risk of respiratory system diseases,decrease the risk of neonatal asphyxia in newborns and have no correlation with digestive system diseases. Low birth weight,premature infants and premature infants with low birth weight may lead to cesarean section,thus increasing cesarean section rate.