会阴切开的发生率及影响因素分析

张旱梅; 周利华; 马红; 程玉婷

doi:10.16766/j.cnki.issn.1674-4152.002638

会阴切开的发生率及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002638

1.
安徽医科大学第一附属医院妇产科，安徽合肥 230088
2.
安徽医科大学护理学院，安徽合肥 230088

基金项目:

安徽省省级教学质量工程项目 2019kfkc041

安徽省省级示范基层教研室项目 2020-215

详细信息

通讯作者:
周利华, E-mail: 531879548@qq.com

中图分类号: R714.3 R719
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出版历程
- 收稿日期: 2022-02-12
- 网络出版日期: 2022-11-29

Incidence and influencing factors of perineotomy

1.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230088, China

摘要

摘要: 目的调查分析阴道分娩会阴切开现状，为提高助产质量，减少会阴切开提供干预方向。方法采用便利抽样法, 横断面调查安徽医科大学第一附属医院高新院区2019年1月1日—12月31日阴道分娩产妇年龄、产次、产程、孕周、妊娠合并症或/和并发症、会阴切开及切开指征等临床资料，统计分析其会阴切开率及影响因素。结果纳入阴道分娩产妇1 992例中700例行会阴切开术，年平均会阴切开率为35.14%。最常见的切开指征是会阴条件差(356例，50.86%)、胎心异常(190例，27.14%)和羊水Ⅲ度污染(75例，10.71%)。单因素分析显示孕妇年龄(Z=4.586，P＜0.001)、文化程度(Z=2.414，P=0.016)、助产士工作年限(Z=2.398，P=0.016)、产次(Z=14.307，P＜0.001)、第二产程时间(χ²=300.016，P＜0.001)、孕周(Z=3.104，P=0.002)、有无妊娠合并症或并发症(χ²=60.435，P＜0.001)及瘢痕子宫(χ²=6.591，P=0.010)是会阴切开的影响因素。基于单因素分析结果进行多因素logistic回归分析，结果显示孕妇年龄＞35岁、助产士工作年限＞10年、第二产程时间＞120 min以及瘢痕子宫是会阴切开的独立危险因素(均P＜0.05)。结论目前会阴切开率仍较高，需要进一步加强对助产士的培训。可通过提高助产士对产妇会阴条件、产程和母儿情况的综合评估水平以提高助产质量，降低会阴切开率，改善产妇产后生活质量。
- 阴道分娩 /
- 会阴切开 /
- 影响因素
Abstract: Objective To investigate and analyse the situation of episiotomy in vaginal delivery to provide intervention direction for improving the quality of midwifery and reducing the rate of episiotomy. Methods The convenience sampling method was used to conduct a cross-sectional survey of vaginal delivery patients in the Gaoxin Branch of the First Affiliated Hospital of Anhui Medical University from January 1 to December 31, 2019, including their age, times of delivery, course of delivery, gestational weeks, pregnancy complications or/and complications, perineum incision and its indications. The perineum incision rate and its influencing factors were statistically analyzed. Results A total of 1 992 cases of vaginal delivery were included, of which 700 cases underwent episiotomy. The annual average rate of episiotomy was 35.14%. The top three indications for perineotomy were poor perineal condition (356 cases, 50.86%), abnormal foetal heart rate (190 cases, 27.14%) and amniotic fluid Ⅲ degree contamination (75 cases, 10.71%). Univariate analysis showed that age (Z=4.586, P < 0.001), education level(Z=2.414, P=0.016) of pregnant women, working years of midwives (Z=2.398, P=0.016), parity (Z=14.307, P < 0.001), the second stage of labour time (χ²=300.016, P < 0.001), gestational weeks (Z=3.104, P=0.002), with or without pregnancy complications or complications (χ²=60.435, P < 0.001) and scar uterus (χ²=6.591, P=0.010) were the influencing factors of episiotomy. Multivariate logistic regression analysis based on the results of univariate analysis showed that the age of pregnant women >35 years, midwife working experience >10 years, the second stage of labour time >120 minutes and scar uterus were independent risk factors of episiotomy (all P < 0.05). Conclusion At present, the rate of episiotomy remains high, and the training of midwives needs to be further strengthened. This work can be used to enhance the quality of midwifery, reduce the rate of episiotomy and improve the quality of postpartum life by improving the midwife ' s comprehensive assessment of perineal conditions, labour process and maternal and foetal conditions.
- Vaginal delivery /
- Perineal incision /
- Influencing factors

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表 1 会阴切开产妇会阴切开指征统计[例(%)]

Table 1. Statistics of indications of perineotomy in parturient women [cases (%)]

项目	会阴切开
会阴条件(包括会阴炎症、水肿、会阴体过短、弹性差等)	356(50.86)
胎心异常(胎心慢、胎心快、早期减速或变异减速)	190(27.14)
羊水Ⅲ度污染	75(10.71)
胎儿窘迫	23(3.29)
阴道手术助产	72(10.28)
早产	35(5.00)
产妇缺乏配合	2(0.29)
其他	47(6.71)
注：部分产妇会阴切开指征登记同时有2个或以上，因此表中总数相加>700例。

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表 2 2组产妇一般人口学资料比较[例(%)]

Table 2. Comparison of general demographic data between two groups of parturients [cases (%)]

组别	例数	年龄(岁)				文化程度			家庭所在地
组别	例数	≤24	25~30	31~35	＞35	初中及以下	高中	大学及以上	城镇	农村
非会阴切开组	1 292	98(7.59)	862(66.72)	287(22.21)	45(3.48)	110(8.51)	75(5.81)	1 107(85.68)	682(52.79)	610(47.21)
会阴切开组	700	70(10.00)	513(73.29)	105(15.00)	12(1.71)	48(6.86)	30(4.28)	622(88.86)	349(49.86)	351(50.14)
统计量		4.586^a				2.414^a			1.560^b
P值		＜0.001				0.016			0.212
注：^a为Z值，^b为χ²值。

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表 3 2组产妇会阴切开影响因素的单因素分析[例(%)]

Table 3. Univariate analysis of influencing factors of parturient perineotomy in 2 groups [cases (%)]

项目	非会阴切开组(n=1 292)	会阴切开组(n=700)	统计量	P值
助产士工作年限(年)			2.398^a	0.016
1~3	550(42.57)	245(35.00)
4~6	263(20.36)	158(22.57)
7~10	357(27.63)	223(31.86)
＞10	122(9.44)	74(10.57)
产次			14.307^a	< 0.001
第1次	811(62.77)	646(92.29)
第2次	463(35.84)	51(7.29)
第3次	18(1.39)	3(0.42)
新生儿体重(g)			1.217^a	0.224
≤2 500	47(3.64)	29(4.14)
2 501~3 000	299(23.14)	135(19.29)
3 001~3 500	606(46.90)	342(48.86)
3 501~4 000	301(23.30)	175(25.00)
＞4 000	39(3.02)	19(2.71)
第二产程时间(min)			300.016^b	< 0.001
≤30	583(45.12)	202(28.86)
31~60	330(25.54)	204(29.14)
61~120	162(12.54)	191(27.29)
＞120	23(1.78)	89(12.71)
无明确时限	194(15.02)	14(2.00)
孕周(周)			3.104^a	0.002
28~31⁺⁶	13(1.01)	4(0.57)
32~34⁺⁶	8(0.62)	12(1.71)
35~36⁺⁶	33(2.55)	31(4.43)
37~39⁺⁶	764(59.13)	329(47.00)
40~42	474(36.69)	324(46.29)
并发症和/或合并症			60.435^b	< 0.001
无	560(43.34)	180(25.71)
有	732(56.66)	520(74.29)
妊娠期糖尿病	181(14.01)	90(12.86)	0.513^b	0.474
妊娠期高血压疾病	53(4.10)	41(5.86)	3.110^b	0.078
胎膜早破	302(23.37)	163(23.29)	0.002^b	0.964
妊娠合并心脏疾病	4(0.31)	2(0.29)	0.112^b	0.737
妊娠合并肝内胆汁淤积症	5(0.39)	1(0.14)	0.272^b	0.602
胎儿宫内发育迟缓	5(0.39)	1(0.14)	0.272^b	0.602
瘢痕子宫	5(0.39)	10(1.43)	6.591^b	0.010
妊娠合并甲减	68(5.26)	39(5.57)	0.085^b	0.771
妊娠合并子宫肌瘤	11(0.85)	8(1.14)	0.408^b	0.523
妊娠合并乙肝	45(3.48)	28(4.00)	0.344^b	0.558
妊娠合并梅毒	3(0.23)	2(0.29)	0.058^b	0.809
妊娠合并贫血	43(3.33)	26(3.71)	0.202^b	0.653
羊水过少	42(3.25)	30(4.29)	1.396^b	0.237
前置或低置胎盘	2(0.15)	2(0.29)	0.010^b	0.921
帆状或球拍状胎盘	10(0.77)	2(0.29)	1.084^b	0.298
脐带绕颈	86(6.66)	56(8.00)	1.238^b	0.266
其他合并症或并发症	104(8.05)	99(14.14)	18.418^b	1.773
注：^a为Z值，^b为χ²值。(1)第二产程无明确时限是指产程进展过快，未观察到明确宫口开全时间。(2)因部分产妇同时合并2种或2种以上合并症或并发症，所以表中总数相加>1 992例。

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表 4 变量赋值表

Table 4. Variable assignment table

变量	赋值方法
年龄	≤24岁=0；25~30岁=1；31~35岁=2；＞35岁=3
文化程度	初中及以下=0；高中=1；大学及以上=2
助产士工作年限	1~3年=0；4~6年=1；7~10年=2；＞10年=3
产次	第1次=0；第2次=1；第3次=2
第二产程时间	≤30 min=0；31~60 min=1；61~120 min=2；＞120 min=3；无明确时限=4
孕周	28~31⁺⁶周=0；32~34⁺⁶周=1；35~36⁺⁶周=2；37~39⁺⁶周=3；40~42周=4
瘢痕子宫	否=0；是=1
会阴切开	否=0；是=1

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表 5 会阴切开影响因素的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of influencing factors of perineotomy

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄
25~30岁	0.619	0.400	2.395	0.122	1.856	0.848~4.063
31~35岁	0.623	0.362	2.965	0.085	1.864	0.918~3.786
＞35岁	0.830	0.365	5.173	0.023	2.294	1.122~4.692
文化程度
高中	0.210	0.149	1.981	0.159	1.233	0.921~1.651
大学及以上	-0.017	0.215	0.007	0.935	0.983	0.644~1.499
助产士工作年限
4~6年	0.119	0.171	0.483	0.487	1.126	0.806~1.574
7~10年	0.202	0.181	1.240	0.265	1.223	0.858~1.745
＞10年	0.342	0.155	4.883	0.027	1.408	1.039~1.906
产次
第2次	0.654	0.518	1.595	0.207	1.923	0.697~5.305
第3次	0.515	0.514	1.007	0.316	1.674	0.612~4.583
第二产程时间
31~60 min	0.226	0.182	1.547	0.214	1.253	0.878~1.789
61~120 min	0.158	0.171	0.854	0.355	1.171	0.838~1.638
＞120 min	0.354	0.156	5.171	0.023	1.425	1.050~1.933
无明确时限	-1.638	0.277	34.977	＜0.001	0.194	0.113~0.334
孕周
32~34⁺⁶周	-0.509	0.602	0.715	0.398	0.601	0.185~1.957
35~36⁺⁶周	-0.983	0.574	2.930	0.087	0.374	0.121~1.153
37~39⁺⁶周	0.376	0.262	2.062	0.151	1.457	0.872~2.436
40~42周	-0.142	0.099	2.064	0.151	0.867	0.714~1.053
瘢痕子宫	-1.637	0.669	5.990	0.014	0.195	0.052~0.722

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