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目的探讨选择性剖宫产对(近)足月儿呼吸窘迫综合征(RDS)发生的影响。方法以2008年11月-2009年10月在郑州大学第三附属医院NICU住院的76例诊断为RDS的(近)足月儿为研究对象,分析其分娩方式、胎龄分布。RDS(近)足月儿根据分娩方式分为2组:选择性剖宫产组和阴道分娩组,比较不同分娩方式RDS发生风险的高低;足月儿选择性剖宫产组根据胎龄分为2组,37～38+6周组和39～41+6周组,比较不同胎龄选择性剖宫产RDS发生风险的高低。结果 76例RDS(近)足月儿中63例为选择性剖宫产,占82.9%。(近)足月儿选择性剖宫产组RDS发生风险显著高于阴道分娩组(OR=2.38,95%CI1.06～5.33,P<0.05),随着胎龄增加,RDS发病例数逐渐降低,但差异无统计学意义(P>0.05)。足月儿选择性剖宫产组RDS发生风险显著高于阴道分娩组(OR=4.14,95%CI1.58～10.90,P<0.01),这种风险在37～38+6周组显著升高(OR=4.50,95%CI1.10～18.20,P<0.05),39周之后不再升高,且与阴道分娩组相比差异无统计学意义(P>0.05)。结论选择性剖宫产是(近)足月儿发生RDS的重要危险因素,且选择性剖宫产时机对(近)足月儿发生RDS也很重要。如果条件允许,足月儿选择性剖宫产分娩应在39周以后进行,可显著减少RDS发生。
Objective To investigate the effect of selective cesarean section on the occurrence of respiratory distress syndrome (RDS) in (near) full-term infants. Methods From November 2008 to October 2009 at the NICU of Zhengzhou University Third Affiliated Hospital of 76 patients diagnosed as RDS (near) full-term children as the research object, analysis of their mode of delivery, gestational age distribution. RDS (near term) children were divided into two groups according to mode of delivery: selective cesarean section group and vaginal delivery group, compared the different modes of delivery risk of RDS; term cesarean section group according to gestational age was divided into 2 groups, 37 ~ 38 + 6 weeks group and 39 ~ 41 + 6 weeks group. The risk of RDS in different gestational age-selective cesarean section was compared. Results Sixty-six of 76 RDS (near term) full-term infants were selective cesarean, accounting for 82.9%. The risk of RDS in term (up to) full-term elective cesarean delivery was significantly higher than that in vaginal delivery (OR = 2.38,95% CI 1.06-5.33, P <0.05). As the gestational age increased, Lower, but the difference was not statistically significant (P> 0.05). The risk of RDS in term cesarean section group was significantly higher than that in vaginal delivery group (OR = 4.14, 95% CI 1.58-10.90, P <0.01), and the risk was significantly increased in 37-38 + 6 weeks group (OR = 4.50, 95% CI 1.10-18.20, P <0.05), no longer increased after 39 weeks, and there was no significant difference compared with vaginal delivery group (P> 0.05). Conclusion Selective cesarean section is an important risk factor for RDS in term infants, and selective cesarean delivery timing is also important for RDS in (near) full-term infants. If conditions permit, term cesarean section delivery should be performed after 39 weeks, can significantly reduce the occurrence of RDS.