北京朝阳区剖宫产现状及影响因素的 Logistic回归分析

目的：探讨北京朝阳区剖宫产率的下降空间及控制的合理水平。针对相关影响因素提出干预措施。方法采用随机抽样方法在22家助产机构中抽取孕产妇3030名，医护人员310名。自行设计调查表对剖宫产影响因素进行调查，对于剖宫产病历由课题组专家通过回顾性病历分析进行指征审核，并对结果数据进行统计分析。结果全区剖宫产比例为48．05％，社会因素及剖宫产医学指征掌握不准确的比例共占21．11％；民营助产机构剖宫产比例为53．53％，处于全区较高水平；民营助产机构剖宫产比例高于公立助产机构（χ^2＝4．631，P＝0．018＜0．05）。大多数医护人员对于剖宫产的相关态度及行为是正确的，但相关知识有待加强，其在选择剖宫产的过程中还受到孕产妇、家属及医疗纠纷等社会因素的影响；多因素分析共筛选出7个因素能影响孕产妇分娩方式，包括“城市户籍”、“非自费”、“剖宫产史”、“产前希望的分娩方式为自然分娩”、“认为剖宫产对母亲安全”、“认为自然分娩的孩子更健康、更聪明”、“认为自然分娩会影响产后性生活”。 OR值分别为：1．575、1．722、16．977、0．107、1．836、0．561和1．569，均P＜0．05。结论通过压缩社会因素剖宫产及正确掌握剖宫产手术指征，减少民营机构剖宫产率可降低全区平均剖宫率。针对城镇户籍、非自费孕妇应进行促进自然分娩的重点宣教。

Logistic regression analysis of current status of cesarean section and its influencing factors in Chaoyang District of Beijing

Objective To explore the decline space of cesarean section rate and reasonable level of control in Chaoyang District of Beijing , so as to put forward intervention measures based on influencing factors .Methods Random sampling method was used to extract 3 030 puerpera and 310 medical staff from 22 midwifery institutions .Survey on influencing factors of cesarean section was conducted with self-designed questionnaires , and expert group and investigators verified the indications of cesarean section through retrospective analysis of medical records.Statistical analysis was conducted on survey data .Results The cesarean section rate was 48.05% in the district.The social factors and inaccurate medical indications accounted for 21.11%.Cesarean section rate in private institutions was 53.53%, which was relatively high in the whole district .The rate of cesarean section in private midwifery institutes was higher than the public ones （χ^2 =4.631, P=0.018〈0.05）.Most of the attitudes and behaviors of medical staff to cesarean section were correct , but the knowledge needed to be strengthened .The process of choosing cesarean section was also affected by pregnant women , families and social factors .Multi-factor analysis indicated seven factors influencing maternal delivery mode , including “urban residents”, “free medical service”, “a history of cesarean section”,“natural birth as childbirth way of prenatal hope”,“thinking cesarean section as a safe delivery way for motherhood”,“thinking the children of natural birth more healthy and wisdom”, and“thinking natural birth affecting postpartum sexual life” （ OR value was 1.575, 1.722, 16.977, 0.107, 1.836, 0.561 and 1.569, respectively, all P〈0.05）.Conclusion The average rate of cesarean section of the district can be decreased by reducing cesarean section rate in private institutions by means of compressing social factors and correctly grasping cesarean section indications .Intensive propaganda and education of promoting natural birth