CAJ | 학술논문

目的：探讨发生肩难产的高危因素、临床预测及处理方法，减少母儿并发症的发生。方法回顾性分析肩难产41例患者的临床资料，将其分为巨大儿组及正常体质量儿组，分析其发生原因、母儿并发症及处理方法。结果41例肩难产中，巨大儿组产后出血、新生儿窒息，明显高于正常体质量儿组（χ2＝4．439、5．225，均 P ＜0．05。妊娠期糖尿病、会阴 III 度裂伤、新生儿损伤：巨大儿组均高于正常体质量儿组，但差异均无统计学意义（χ2＝0．966、1．267、1．287，均 P ＞0．05）。助产方法：巨大儿组较正常体质量儿组明显增加（巨大儿组单用 McRobert 法6例明显低于正常体质量儿组15例；行 McRobert ＋压前肩法12例，明显高于正常体质量儿组3例，差异有统计学意义（χ2＝10．896、5．036，均 P ＜0．05）。巨大儿组使用3种及3种以上方法助产例数高于正常体质量儿组，但差异无统计学意义[χ2＝0．139、1．267（似然比），P ＞0．05]。结论肩难产是一种严重的产科急症，巨大儿是发生肩难产的主要的高危因素，因此正确地预防、预测、产时早期识别及正确处理肩难产，是减少母儿并发症的重要措施。
목적：탐토발생견난산적고위인소、림상예측급처리방법，감소모인병발증적발생。방법회고성분석견난산41례환자적림상자료，장기분위거대인조급정상체질량인조，분석기발생원인、모인병발증급처리방법。결과41례견난산중，거대인조산후출혈、신생인질식，명현고우정상체질량인조（χ2＝4．439、5．225，균 P ＜0．05。임신기당뇨병、회음 III 도렬상、신생인손상：거대인조균고우정상체질량인조，단차이균무통계학의의（χ2＝0．966、1．267、1．287，균 P ＞0．05）。조산방법：거대인조교정상체질량인조명현증가（거대인조단용 McRobert 법6례명현저우정상체질량인조15례；행 McRobert ＋압전견법12례，명현고우정상체질량인조3례，차이유통계학의의（χ2＝10．896、5．036，균 P ＜0．05）。거대인조사용3충급3충이상방법조산례수고우정상체질량인조，단차이무통계학의의[χ2＝0．139、1．267（사연비），P ＞0．05]。결론견난산시일충엄중적산과급증，거대인시발생견난산적주요적고위인소，인차정학지예방、예측、산시조기식별급정학처리견난산，시감소모인병발증적중요조시。
Objective To explore the high risk factors,clinical prediction and treatment methods of the shoulder dystocia to reduce the incidence of complications in mother and child.Methods The clinical data of 41patients with shoulder dystocia were retrospectively analyzed,and they were divided into the huge baby group and normal weight baby group.The causes,incidence of complications in mother and child and the treatment were ana-lyzed.Results In the 41 cases of shoulder dystocia,the incidence of complications in mother and child in the macro-somia group was higher than the normal weight baby group(the incidence of postpartum hemorrhage,the incidence of neonatal asphyxia in the huge baby group were higher than the normal weight baby group,χ2 =4.439,5.225,all P <0.05;the incidence of gestational diabetes mellitus,III -degree perineal lacerations,new born injury were higher than the normal weight baby,but the difference between the two groups was no significant),the midwife methods was more than normal weight baby group(6 huge baby cases using McRobert method was lower than the 15 normal weight baby cases;12 huge baby cases using McRobert method and press -front shoulder method was higher than the 3 normal weight baby cases,the difference between the two groups was significant,χ2 =10.896,5.036,P <0.05;using 3 and 3 above methods in huge baby group was more than normal weight baby group,but the difference between the two groups was no significant,χ2 =0.139,1.267(likelihood ratio),P >0.05,and the difference between the two groups reach the significant level.Conclusion The shoulder dystocia is a serious maternity emergency,the huge baby is the high factor of the shoulder dystocia,the important treatment to reduce the incidence of complications in mother and child is the correct prevention,prediction,early identification and proper treatment.