摘要
目的 分析西藏高原地区剖宫产率的变化情况和剖宫产的临床指征，为全区进一步降低剖宫产率、提高产科质量提供精准的科学依据。方法 回顾性分析2008年5月至2017年5月在西藏自治区人民医院妇产科住院部进行就诊的12850例孕产妇的临床资料，对比西藏自治区人民医院妇产科近9年的剖宫产现状。结果 在12850例孕产妇中，剖宫产者3183例，总剖宫产率为24.77%；每年剖宫产率分别为：2008年为34.14%（252/738），2009年为28.88%（335/1160），2010年为23.72%(265/1117)，2011年22.49%(262/1165)，2012年为24.51%(314/1281)，2013年为23.60%(312/1322)，2014年为24.68%(445/1803)，2015年为19.44%(383/1970)，2016年为25.35%(421/1661)，2017年为30.65%(194/633)，9年间剖宫产率差异有显著统计学意义（X2=92.307，P<0.01）;有医学指征的剖宫产因素前五位为：瘢痕子宫（21.61%）、子痫前期（14.54%）、臀位(10.80%)、脐绕颈(10.13%)、胎膜早破(8.38%)。结论 随着年限的增长剖宫产率有显著下降趋势（P<0.01），“二孩”政策放开后，剖宫产率有上升倾向；瘢痕子宫为最主要的剖宫产指征；西藏高原地区因其特殊的文化背景和高寒缺氧的特殊自然环境影响着剖宫产术指征和剖宫产率，所以要求高原产科医生合理掌握剖宫产术指征，降低人为主观因素剖宫产率，提高高原地区产科质量 。
关键词： 高海拔；剖宫产率；临床指征
Abstract
Objective: To analyze the changes of cesarean section rate and the clinical indications of cesarean section in the Tibetan Plateau, and to provide the scientific basis for further reduction of cesarean section rate and improve the quality of obstetrics. Methods: We retrospectively analyzed the clinical data of 12850 pregnant women who were treated in the department of obstetrics and gynecology of the People's Hospital of Tibet Autonomous Region from May 2008 to May 2017, and then comparing the status of cesarean section in the past 9 years in the department of obstetrics and gynecology of People 's Hospital of Tibet Autonomous Region. Results: Among the 12850 pregnant women, 3183 patients were caesarean section, and the total cesarean section rate was 24.77%; The annual rate of cesarean section was 34.14% _(252/738) in 2008, 28.88%_(335/1160) in 2009, 23.72%_(262/1117) in 2010,22.49%_(262/1165) in 2011, 24.51%_(314/1281) in 2012, 23.60%_(312/1322) in 2013, 24.68%_(445/1803) in 2014, and 19.44%_(383/1970) in 2015, and 25.35%_(421/1661) in 2016, and 30.65%_(194/633) in 2017, there was significant difference in cesarean section rate among 9 years（χ2=92.307，P<0.01）; The top five factors of cesarean section were: scar uterus (21.61%), preeclampsia (14.54%), breech (10.80%), Umbilical around the neck (10.13%) and Premature rupture of membranes (1.6%). Conclusion s: With the growth of years n, the rate of cesarean section is decreasing(;The rate of cesarean section increasES after the releasing of "two-child" policy; Scar of the uterus is the most important indication of cesarean section; Tibet Plateau region because of its special cultural background and the special natural environment of cold and hypoxia affects the cesarean section indications and cesarean section rate, so it requires the obstetricians to master the indications of cesarean section, reduce the subjective factor profile palace yield, and improve the quality of obstetrics in the plateau.
Key words： High altitude; cesarean section rate; clinical indication
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