产瘫危险因素的病例对照研究

目的研究发生产瘫的各种危险因素及其危害的程度。方法采用病例对照研究方法；选择上海市八家医院在1988-2002年出生的31例产瘫患儿及其母亲的病历资料为病例组；按1：4配对，在同一个医院选择出生时间相差在1年以内，无臂丛神经损伤的新生儿及其母亲作对照组，共124名。对病例与对照组的孕前、孕期、分娩过程中的多种因素进行流行病学调查，内容包括孕妇基本情况、分娩时情况和新生儿情况。对与产瘫相关联的因素进行单因素、多因素条件logistic回归分析。结果单因素条件logistic回归分析发现有12个因素与产瘫有关。多因素条件logistic回归分析显示产瘫与手术分娩、器械辅助分娩、出生体重、孕前体重指数（BMI）有关，其OR值分别为0．060、65．237、35．468、23．901；发生产瘫的危险因素及其危害程度的大小依次是：产钳助产、巨大儿、孕前BMI过大（≥21），手术分娩是产瘫的保护因素。结论控制母亲孕前体重、降低巨大儿发生率，谨慎使用产钳，加强高危孕妇产程监护等是预防产瘫的综合措施。

A case-control study on the risk factors related to obstetric brachial plexus palsy

OBJECTIVE: To identify the risk factors and related degrees associated to obstetric brachial plexus palsy(OBPP). METHODS: A case-control study was performed. Neonatal records of thirty-one cases with OBPP and their corresponding maternal records from the Department of Gynecology and Obstetrics of eight hospitals in Shanghai city from 1988 to 2002 were reviewed. Four controls, all living in Shanghai were selected to match each case and were born within the same year at the same hospital. The control group also included 124 cases without OBPP. According to the uniformed data and tables used were from medical records and from pregnant women. Epidemiological study was carried out on both case group and control group. Variables for analyses would include: (1) race, age, height, family history, pre-pregnancy weight, body mass index at the pre-pregnancy (weight/height2) on those pregnant women as well as on parity of their mothers; (2) the process of delivery which includeing clinic pelvis evaluation, height of uterus, abdomen circumference,antepartum weight,body mass index before delivery, mode of delivery,the duration of active phase and 2nd stage of labor, shoulder dystocia; (3) on neonates: sex, gestational age, birth weight,affected limb, Apgar scores of 1 and 5 minutes, other birth trauma and resuscitation of infant. Statistical tests applied to these data would include Student's T test for continuous variables and chi2 analysis for discrete data. Risk calculation of OBPP was performed by univariable and multivariable conditional logistic regression analysis. RESULTS: 12 factors related to expsure were identified for OBPP through univariable conditional logistic regression analysis. When multivariable conditional logistic regression model at P = 0.1 was applied, four factors such as cesarean (OR = 0.060), forceps (OR = 65.237), birth weight (OR = 35.468), and pre-pregnancy body mass index (OR = 23.901) were selected. CONCLUSION: Forceps delivery,macrosomia, and increase of pre-pregnancy body mass index (> or = 21) were risk factors of OBPP in the order of degrees to risk while cesarean seemed to serve as a protective factor.