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目的分析咸宁市孕产妇死亡变化趋势及影响因素,探讨干预措施,为降低咸宁市孕产妇死亡率提供科学依据。方法按照孕产妇死亡监测方法,通过咸宁市妇幼信息监测系统及三级妇幼保健网,收集2004-2015年咸宁市各县区妇幼保健机构上报的妇幼卫生年报数据、孕产妇死亡病例资料及孕产妇死亡报告卡,再经审核及县、市两级评审专家死亡评审,明确死因和诊断。采用SPSS22统计软件对咸宁市孕产妇死亡率变化趋势及其相关因素进行统计分析。结果 (1)咸宁市孕产妇死亡率从2004年的36.42/10万下降到2015年的7.66/10万,降幅为78.97%,年下降速率为6.58%,孕产妇死亡率呈下降趋势(χ~2=89.292,P<0.001)。(2)死因前5位依次为:产科出血、妊娠合并内外科疾病、羊水栓塞、妊娠期高血压疾病、产褥感染、麻醉意外。其中产科出血导致的死亡由2004-2009年的52.38%下降到2010-2015年的37.50%,妊娠合并内外科疾病导致的死亡由2004-2009年的16.67%上升到2010-2015年的29.17%。(3)死亡孕产妇分娩地点50.00%、死亡地点45.45%都在县区级医院。(4)78.79%的死亡孕产妇产前检查(产检)次数<5次。结论咸宁市近12年孕产妇死亡率整体呈下降趋势。产科出血仍然是孕产妇死亡的首位原因,但妊娠合并内外科疾病等间接产科因素引起的死亡呈上升趋势,提示孕产妇死亡控制已面临间接产科死亡因素引起的新挑战,及时调整干预措施:规范孕产妇健康管理,加强基层医疗机构产科建设,建立标准化的地市级孕产妇急救中心是有效降低孕产妇死亡率的重要措施。
Objective To analyze the changing trend and influencing factors of maternal mortality in Xianning and to explore intervention measures to provide scientific basis for reducing maternal mortality in Xianning. Methods According to the maternal death monitoring method and the Xianning Maternal and Child Health Information System and the Maternal and Child Health Care Network, the data of maternal and child health annual reports, maternal deaths and maternal deaths reported by the MCH institutions in Xianning counties from 2004 to 2015 were collected. Death report card, and then reviewed and county, city appraisal experts death review, a clear cause of death and diagnosis. Using SPSS22 statistical software to analyze the trend of maternal mortality in Xianning and its related factors. Results (1) The maternal mortality rate in Xianning dropped from 36.42 / 100 000 in 2004 to 7.66 / 100 000 in 2015, a decrease of 78.97% with an annual rate of 6.58%. The maternal mortality rate showed a downward trend (χ ~ 2 = 89.292, P <0.001). (2) The top five causes of death were obstetric bleeding, pregnancy and surgical diseases, amniotic fluid embolism, hypertensive disorder of pregnancy, puerperal infection and anesthesia accidents. Among them, the death caused by obstetric hemorrhage dropped from 52.38% in 2004-2009 to 37.50% in 2010-2015. The death caused by internal diseases and surgical diseases during pregnancy rose from 16.67% in 2004-2009 to 29.17% in 2010-2015. (3) 50.00% of maternal deaths and 45.45% of deaths were all in county-level hospitals. (4) 78.79% of the deaths of pregnant women prenatal examination (inspection) the number of <5 times. Conclusion The overall maternal mortality rate in Xianning City has been declining in recent 12 years. Obstetric bleeding is still the leading cause of maternal death, but the incidence of indirect obstetric factors such as pregnancy and gynecology diseases is on the rise. This indicates that the control of maternal death has been confronted with new challenges arising from indirect obstetric mortality and the timely adjustment of intervention measures: Maternal health management, strengthen the obstetric construction of primary medical institutions, the establishment of standardized municipal maternal emergency center is an important measure to effectively reduce maternal mortality.