分娩性臂丛神经损伤危险因素的病例对照研究

目的：明确分娩性臂丛神经损伤的危险因素并提出预防措施。方法：采用病例对照研究，按1：4配对，共收集了出生在1988年至2001年的26个病例和104个对照婴儿，对两组计数资料和计量资料分别进行统计学处理，用条件Logistic回归分析其危险因素。结果：胎儿的出生体重，Apgar评分，分娩方式，母亲的活产次数，第一产程活跃期和第二产程持续时间，胎方位，有无抢救史，是否合并其它产伤等方面，病例组与对照组之间的差异均有显著性意义（P＜0．05），趋势卡方检验表明，随着分娩方式（手术产，自然分娩，产钳助产）级别的增加，发生臂丛神经损伤的可能性也增加（P＜0．001），经条件Logistic回归分析确定巨大儿（出生体重4000g)，产钳辅助分娩，胎方位为枕横位或枕后位是分娩性臂丛神经损伤的危险因素，结论：出生体重是分娩性臂丛神经损伤最强的危险因素，分娩方式与出生体重，胎方位之间均有协同作用，在分娩方式中，手术分娩是其保护因素。

Case control study of risk factors in obstetrical brachial plexus palsy

Objective To identify risk factors associated with obstetrical brachial plexus palsy,and forward its preventive measures. Methods Twenty-six cases with obstetrical brachial injury, who were born from 1988 to 2001 ,were reviewed. The control group consisted of 104 randomly selected normal neonates. We used multivariable conditional logistic regression to derive the risk factors. Results There was statistically significant difference between the case group and the control group in mean birth weight, Apgar scores, mode of delivery, parity, the duration of active phase and 2nd stage of labor, fetal position, frequency of resuscitation, and a combination of other obstetrical injuries. Chi-square for trend indicated that there was linear trend between the mode of delivery(cesarean, spontaneous delivery, forceps) and brachial plexus injuries. The analysis of conditional logistic regression showed that macrosomia (birth weight 4 000g), forceps delivery and occipitoposterior or occipitotransverse in fetal position were risk factors. Conclusions Our study suggests that birth weight is the stongest factor among the risk factors. The mode of delivery has synergy with birth weight and fetal position. Among the mode of delivery, surgery delivery is a protective factor.