上海市非医学指征剖宫产供需双方影响因素研究

摘要

目的：探讨在本地区特有的人口学、经济文化特征以及医疗保健水平下，非医学指征剖宫产的影响因素，以此为依据，制定“降剖”综合性干预策略和政策建议。方法自行设计调查表，分别在上海市助产医疗机构开展产科服务供需双方问卷调查，利用多水平Logistic回归模型，在控制可能混杂因素后，分析产科服务供（高水平变量）需（低水平变量）双方两个层面，探讨非医学指征剖宫产的影响因素。结果多水平Logistic回归模型分析结果显示，“医院定期对剖宫产手术指征进行质控”可减少非医学指征剖宫产的发生风险（OR＝0．572，P＜0．05）；而“产妇怕痛”“怕分娩不顺再开刀吃二茬苦”“对分娩过程没信心和安全感”“家人、朋友推荐”和“认为手术更快捷安全”，更易增加非医学指征剖宫产的发生风险（ OR值分别为51．045、24．161、11．909、1．729和37．330，均P＜0．05）。结论根据研究结果，将推行产时适宜技术、加强促进自然分娩的健康教育以及调整孕产期保健费用等作为降低剖宫产率的政策建议。%Objective To explore the influencing factors of non-medical indications for cesarean section under region-specific demographic, economic and cultural characteristics and level of health care, so as to make basis for developing a comprehensive intervention strategy to reduce the rate of cesarean section.Methods The survey among providers and demanders for obstetric services was conducted in obstetric medical institutions in Shanghai using self-designed questionnaires.The provider ( high-level variable) and demander ( low-level variable) of obstetric service were analyzed to explore influencing factors of non-medical indications for cesarean section by using multi-level Logistic regression model after controlling possible confounding factors.Results Multi-level Logistic regression analysis showed that “hospital conducts quality control of surgical indications for cesarean section regularly” may reduce the risk of cesarean section for non-medical indications (OR=0.572,P<0.05).“Being afraid of pain during child birth,” “fear of cesarean due to difficult birth and experience second pain”,“no confidence on delivery process and security”,“introduced by family and friend”and“considering cesarean as being more efficient and safe” increased the risks of cesarean section due to non-medical indications(OR value was 51.045,24.161,11.909,1.729 and 37.330,respectively, all P <0.05).Conclusion Based on the findings, launching production technology, strengthening health education and adjusting maternal health care cost would be considered as policy recommendations to reduce cesarean section rates.