CAJ | 학술논문

目的：探讨在基层诊所和县级医院行人工流产的效果及危险因素。方法收集磐安县人民医院和同一地区基层诊所2013年5月到2014年12月采取流产的患者500例，其中基层诊所人工流产患者225例，县级医院275例，通过问卷调查收集有关数据并进行分析。结果基层诊所的药物流产率、选择局部麻醉比例均明显高于县级医院，物理治疗的比例低于县级医院，差异均有统计学意义（χ2值分别为4．343、19．527、88．235，均P＜0．05）。基层诊所的VAS评分、术中出血量、腹痛时间均明显高于县级医院，而复查次数、治疗费用均低于县级医院，差异均有统计学意义（ t值分别为3．125、4．579、5．468、88．235、3．457、7．568，均P＜0．05）；药物流产、VAS评分4分以上、术中出血量大于13mL、腹痛时间1小时以上、无物理治疗、复查次数较少为基层诊所流产发生不良反应的独立危险因素[OR（95％CI）分别为：0．632（0．234～0．987）、0．949（0．543～2．654）、0．983（0．432～2．214）、0．884（0．115～1．563）、2．812（1．123～4．325）、0．75（0．045～1．345），均P＜0．05]。基层诊所的感染率、月经失调发生率、失血过多比例、持续腹痛比例明显的高于县级医院，差异均有统计学意义（χ2值分别为：9．684、10．786、9．169、18．152，均P＜0．05）。结论县级医院人工流产效果明显优于基层诊所，并且不良反应较少，但是基层诊所流产费用明显低于县级医院。
목적：탐토재기층진소화현급의원행인공유산적효과급위험인소。방법수집반안현인민의원화동일지구기층진소2013년5월도2014년12월채취유산적환자500례，기중기층진소인공유산환자225례，현급의원275례，통과문권조사수집유관수거병진행분석。결과기층진소적약물유산솔、선택국부마취비례균명현고우현급의원，물리치료적비례저우현급의원，차이균유통계학의의（χ2치분별위4．343、19．527、88．235，균P＜0．05）。기층진소적VAS평분、술중출혈량、복통시간균명현고우현급의원，이복사차수、치료비용균저우현급의원，차이균유통계학의의（ t치분별위3．125、4．579、5．468、88．235、3．457、7．568，균P＜0．05）；약물유산、VAS평분4분이상、술중출혈량대우13mL、복통시간1소시이상、무물리치료、복사차수교소위기층진소유산발생불량반응적독립위험인소[OR（95％CI）분별위：0．632（0．234～0．987）、0．949（0．543～2．654）、0．983（0．432～2．214）、0．884（0．115～1．563）、2．812（1．123～4．325）、0．75（0．045～1．345），균P＜0．05]。기층진소적감염솔、월경실조발생솔、실혈과다비례、지속복통비례명현적고우현급의원，차이균유통계학의의（χ2치분별위：9．684、10．786、9．169、18．152，균P＜0．05）。결론현급의원인공유산효과명현우우기층진소，병차불량반응교소，단시기층진소유산비용명현저우현급의원。
Objective To investigate the effect and risk factors of artificial abortion performed in primary clinics and county leveled hospitals.Methods Totally 500 cases of abortion were collected from May 2013 to December 2014 in Pan’ an County People’ s Hospital and primary clinics, including 225 cases in primary clinics and 275 cases in Pan’ an County People’ s Hospital.Basic situations of patients were collected by questionnaires.Results Compared with county leveled hospitals, primary clinics had higher drug abortion rate and higher proportion in choosing local anesthesia, but the percentage of physical therapy was lower with significant differences (χ2 value was 4.343, 19.527 and 88.235, respectively, all P<0.05).Primary clinics had higher VAS score, intraoperative blood loss and abdominal pain time, but the times of reexamination and treatment cost were lower significantly (t value was 3.125, 4.579, 5.468, 88.235, 3.457 and 7.568, respectively, all P<0.05).Drug abortion, VAS score higher than 4, intraoperative blood loss more than 13mL, abdominal pain longer than 1 hour, without physical therapy and less frequent reexamination were independent risk factors of adverse reactions in primary clinics [OR(95%CI)value was 0.632(0.234-0.987), 0.949(0.543-2.654), 0.983(0.432-2.214), 0.884(0.115-1.563), 2.812(1.123 -4.325)and 0.75(0.045 -1.345), respectively, all P <0.05].Infection rate, incidence of menstrual disorder, proportion of high excessive bleeding and persistent abdominal pain in primary clinics were obviously lower in county leveled hospitals (χ2 value was 9.684, 10.786, 9.169 and 18.152, respectively, all P<0.05).Conclusion Abortion effect in county leveled hospitals is better than in primary clinics with fewer adverse reactions, but the cost is remarkably higher in county leveled hospitals.