四川省城乡居民剖宫产现状及其相关因素分析

目的 在新医改和“全面二孩”大背景下比较四川省城乡居民剖宫产率变化情况并探索影响产妇选择分娩方式的相关因素。方法 采用多阶段分层整群随机抽样的方法，选取1 430名育龄妇女作为研究对象，询问其近5年内最近一次的分娩情况。采用logistic回归模型探索育龄妇女选择剖宫产分娩的相关因素。结果 相对于2013年，城市地区2018年的剖宫产率总体呈下降趋势，而农村地区的剖宫产率呈上升趋势，尤其是在少数民族地区2018年的剖宫产率明显上升，汉族地区人群中剖宫产率无明显变化。年龄（OR = 1.958，P = 0.001）、分娩地点（OR县级以下 VS 县级以上 = 0.469，P＜0.001）、民族（OR少数民族 VS 汉族 = 0.305，P＜0.001）、家距最近医院距离（OR15～29 min VS ＜15 min = 0.535，P＜0.001；OR≥30 min VS ＜15 min = 0.374，P = 0.004）与是否选择剖宫产的关系具有统计学意义。结论 应增加对于少数民族地区，特别是初产妇人群的产前健康教育；进一步加强对县级以上医疗机构过度利用医疗资源行为的监督，以期降低四川省内城乡居民中的剖宫产率。

Analysis of cesarean section status and related factors among urban and rural residents in Sichuan Province

To compare the changes of cesarean section rate among urban and rural residents in Sichuan Province against the backdrop of the new medical reform and the “two-child” policy, and to explore the related factors for choosing delivery mode of women. Methods A multi-stage stratified cluster random sampling method was used to select 1 430 women of childbearing age, and their last delivery in the past 5 years was inquired. Logistic regression model was used to explore the factors related to cesarean section delivery in women of childbearing age. Results Compared with in 2013, the cesarean section rate in urban areas showed a downward trend in 2018, while that in rural areas showed an upward trend, especially in ethnic minority areas where cesarean section rate increased significantly in 2018. The cesarean section rate in non-ethnic minority areas showed no significant change. The cesarean section choice was associated with age(OR=1.958, P=0.001), place of delivery(OR =0.469, P <0.001), ethnic group(OR =0.305, P <0.001), and distance from home to the nearest hospital(OR(15～29 min VS <15 min)=0.535, P<0.001; OR(≥30 min VS <15 min)=0.374, P=0.004). Conclusion Prenatal health education should be enhanced in ethnic minority areas, especially among the population of first-time mothers. Supervision over excessive use of medical resources by medical institutions above the county level should be strengthened in order to reduce the cesarean section rate among urban and rural residents in Sichuan Province.