急诊剖宫产自决定手术至胎儿娩出时间的影响因素及其与新生儿预后的关系

目的:分析剖宫产从决定手术至胎儿娩出时间(DDI)的影响因素,以及急诊剖宫产DDI对新生儿预后的影响.方法:对472例剖宫产患者根据Lucas分类法分为两组:急诊剖宫产组(291例)与非急诊剖宫产组(181例);急诊剖宫产组中分为DDI≤30分钟组和DDI>30分钟组,分别回顾性分析影响DDI的重要因素、以及DDI对新生儿Apgar评分及脐动脉血气的影响.结果:①急诊剖宫产组的DDI为35.5±11.6分钟,其中210例(72.2%)DDI≤30分钟;非急诊剖宫产组DDI为49.3±22.8分钟,其中86例(47.5%)DDI≤30分钟;②急诊剖宫产组中,与DDI>30分钟相比,DDI≤30分钟可明显改善新生儿脐动脉血pH值以及1分钟Apgar评分(P<0.05);但5分钟Apgar评分比较,两组差异无统计学意义(P>0.05);③DDI>30分钟的主要原因为将孕妇由产房或待产室运送至手术室的耗时(56例,69.1%).结论:并非所有急诊剖宫产手术均能达到DDI≤30分钟的标准,尽量缩短DDI时间有助于最终改善新生儿预后.

The Relationship between Decision-to-Delivery Interval in Emergency Caesarean Sections and Neonatal Outcome

Objectlve:To assess the influential factors of decision-to-delivery inteval (DDI) in caesarean section, and its influence on neonatal outcomes.Methods:472 caesarean sections were divided into two groups according to Lucas's classification :the emergency caesarean sections as group 1 (291) ; and the e-lective caesarean sections as group 2 (181).It was divided into DDI ≤30 min group and DDI > 30 mir group in group 1.A retrospective study was performed in DDI, influential factors of DDI, neonatal Apgar score and umbilical arterial blood gas.Results: ①The mean DDI was 35.5±11.6 min in group 1,in wgich DDI≤30 min was 210 cases (72.2%) and 49.3 ±22.8 min in group 2, in which DDI≤30 min was 86 cases (47.5%).②IN group 1,umbilical artery pH and Apgar core at 1 min after birth could be improved sigbificantly in the cases of DDI ≤ 30 min (P<0.05) , but no correlation was found between the DDI and Apgar scrore at 5 min ,as compared with DDI ＞30MIN CASES(p＞0.05).③It was mainly influenced by time taken to get the patient into operation room in DDI >30 min (56 cases, 69.1 %).Concluslons :The recommended DDI ≤30 min is not routinely achieved even in emergency caesarean sections.Shortening DDI as far as pos-sible might improve the neonatal outcome.