论文部分内容阅读
目的:了解云南省不同级别助产机构剖宫产状况,为卫生行政部门提供决策支持。方法:将云南省助产机构按行政隶属分为省、州(市)、县(市、区)、乡(镇)和民营及其他等5个类别,对2008～2010年云南省产科质量情况年报表按上述5个类别分类,再对各类别上报的住院分娩产妇的分娩方式及相关指标在Excel软件中进行统计学分析。结果:2008～2010年云南省助产机构共接产1 369 758人次,顺产956 133人次,达69.80%;剖宫产379 528人次,占27.71%;胎头吸引、产钳助产及臀位助产分别占1.52%、0.42%及0.75%。3年间剖宫产率无明显增高趋势。从不同级别看,剖宫产率以省级为最高,达50.72%;民营及其他机构次之,占47.68%;州(市)级第三,占45.40%;县级占31.72%;乡级为10.19%。在阴道手术助产中,产钳助产术以省级为最高,占1.28%;胎头吸引以县、乡级为最高,分别占1.81%和1.63%。结论:卫生行政及业务主管部门应采取分类指导原则加大对当地县、乡两级高剖宫产率助产机构的监管及督查力度,找出导致当地高剖宫产率的主要原因及影响因素,针对存在的问题制定相应干预措施。业务指导机构应加大对县、乡产科人员适宜技术的培训力度,使其能正确掌握产钳、胎头吸引等阴道助产技术,减少头位难产所致剖宫产。相关部门应加强对民营及其他助产机构的监管,严格助产机构资质和产科人员资格准入,避免不规范行医、趋利剖宫产等不良行为的发生。
Objective: To understand the status of cesarean section in different levels of midwifery in Yunnan Province and provide decision-making support to health administrative departments. Methods: The midwifery institutions in Yunnan Province were divided into five categories according to the administrative affiliation: provincial, state (city), county (city, district), township (town) and private and others. The annual report is classified according to the above five categories, and then statistical analysis is made on the mode of delivery and related indicators of hospitalized delivery women reported in each category in Excel software. Results: From 2008 to 2010, a total of 1 369 758 births were delivered to the birth control institutions in Yunnan Province, 956 133 births were delivered, accounting for 69.80%; 379 528 were caesarean births, accounting for 27.71%; fetal head attraction, forceps delivery and breech assist Production accounted for 1.52%, 0.42% and 0.75% respectively. 3 years cesarean section rate was no significant increase trend. From different levels, the cesarean section rate was the highest in provincial level, reaching 50.72%; followed by private and other institutions, accounting for 47.68%; state (city) level third, accounting for 45.40%; county level accounting for 31.72%; township level 10.19%. In vaginal surgery midwifery, forceps midwifery surgery to the highest level, accounting for 1.28%; fetal head to the county, township level was the highest, accounting for 1.81% and 1.63%. Conclusion: The health administrative departments should take the guiding principles of classification to step up the supervision and supervision on the midwifery rate of cesarean section at local county and township levels, and find out the main reasons leading to the high rate of cesarean section in the local area. Influencing factors, the corresponding problems for the development of appropriate interventions. Business guidance agencies should increase the appropriate county and township obstetrics and technical personnel training to enable them to correctly grasp the forceps, fetal head and other vaginal midwifery techniques to attract, to reduce the first bit of labor due to cesarean section. Relevant departments should strengthen the supervision of the private sector and other midwifery agencies, strict qualifications of midwifery institutions and obstetric staff access, to avoid irregular behavior, profit-making cesarean section and other undesirable behaviors.