Value of rapid response team 5 min emergency cesarean section in reducing decision-to-delivery interval
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摘要:目的 研究快速反应团队训练5 min紧急剖宫产在产科降低自决定手术至胎儿娩出的时间间隔(DDI)中的价值。方法 回顾分析2012年1月—2019年2月本院90例行急诊剖宫产终止妊娠的孕妇临床资料。2012年1月—2013年12月行常规流程急诊剖宫产者作为对照组(n=50)。将2014年1月—2019年2月行5 min紧急剖宫产者为研究组(n=40); 比较团队训练前后剖宫产DDI时间、新生儿及产妇相关结局。结果 2组DDI比较，差异有统计学意义(P < 0.05); 孕妇术中、术后输血、术后伤口感染率无显著差异(P > 0.05)。2组新生儿脐血pH值差异有统计学意义(P < 0.05), 2组Apgar评分、急性呼吸窘迫综合征(ARDS)发生率及新生儿病死率差异无统计学意义(P > 0.05)。结论 加强5 min紧急剖宫产流程训练可有效降低DDI。因此，定期模拟培训是产科重要管理模式，可改善母婴结局。
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关键词:
- 紧急剖宫产术 /
- 快速反应团队 /
- 决定手术至胎儿娩出的时间间隔
Abstract:Objective To study the value of rapid response team 5 min emergency cesarean section in reducing decision-to-delivery interval(DDI).Methods The clinical data of 90 pregnant women undergoing termination of pregnancy by cesarean section in the emergency department of our hospital from January 2012 to February 2019 were retrospectively analyzed. The patients with routine emergency cesarean section from January 2012 to December 2013 were selected as control group (n=50), and those undergoing 5 min emergency cesarean section from January 2014 to February 2019 were as study group (n=40). The DDI, neonatal and maternal related outcomes were assessed.Results There was significant difference in DDI in two groups(P < 0.05). There was no significant difference in intraoperative, postoperative blood transfusion and postoperative wound infection in two groups(P > 0.05). There was significant difference in the pH value of umbilical blood between the two groups (P < 0.05), but no significant differences in Apgar score, incidence of acute respiratory distress syndrome(ARDS) and neonatal mortality between the two groups were observed(P > 0.05).Conclusion DDI can be effectively reduced by strengthening the 5 min emergency cesarean section training. Therefore, regular simulation training is an important management model for obstetrics department, which can improve maternal and infants′outcomes. -
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表 1 2组一般临床资料比较(x±s)[n(%)]
一般资料 研究组(n=40) 对照组(n=50) 分娩孕周/周 37.00±3.60 36.00±5.60 孕妇年龄/岁 32.40±3.20 29.00±7.50 孕次/次 2.16±1.20 1.92±1.10 产次/次 0.90±1.10 0.50±1.20 孕妇BMI/(kg/m2) 24.50±4.00 22.30±4.80 进入产程 17(42.50) 26(52.00) VBAC 5(12.50) 8(16.00) 发热 2(5.00) 6(12.00) 子痫前期 3(7.50) 6(12.00) 胎窘 14(35.00) 30(60.00) 胎盘早剥 10(25.00) 10(20.00) 脐带脱垂 14(35.00) 2(4.00) 子宫破裂 1(2.50) 1(2.00) 腰麻 21(52.50) 50(100.00) BMI: 体质量指数; VBAC: 剖宫产术后阴道分娩。 
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表 2 2组DDI比较(x±s)
min 指标 研究组(n=40) 对照组(n=50) DDI 10.00±5.52* 30.10±7.02 D-E 4.95±4.02* 18.20±3.50 E-S 2.85±2.20* 7.00±3.20 S-D 2.18±1.95 3.30±1.10 DDI: 自决定手术至胎儿娩出的时间间隔; D-E: 决定手术至进手术室时间; E-S: 进手术室至手术开始时间; S-D: 手术开始到胎儿娩出时间。与对照组比较, *P < 0.05。
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表 3 新生儿结局比较(x±s)[n(%)]
项目 研究组(n=40) 对照组(n=50) 体质量/g 2 725.00±823.50 3 021.00±959.50 入NICU 8(20.00) 12(24.00) 发生ARDS 4(10.00) 6 (12.00) 新生儿死亡 4(10.00) 2(4.00) 脐血pH值 7.20±1.94* 6.90±0.91 1 min Apgar评分/分 7.30±2.61 7.20±2.82 5 min Apgar评分/分 8.45±1.38 8.93±0.18 新生儿住院时间/d 8.68±10.30* 3.78±9.50 NICU: 新生儿重症监护室; ARDS: 急性呼吸窘迫综合征; Apgar: 阿普加评分。与对照组比较, *P < 0.05。
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表 4 手术并发症及指标对比(x±s)[n(%)]
项目 研究组(n=40) 对照组(n=50) 术后并发症 术后发热 4(10.00) 8(16.00) 子宫切除 0 0 盆腔血肿 0 0 泌尿系损伤 0 0 伤口愈合不良 1(2.50) 3(6.00) 血栓性疾病 0 0 观察指标 手术时间/min 53.68±10.85 50.20±13.23 出血量/mL 362.50±183.10 314.50±163.60 输血 2(5.00) 4(8.00) WBC/(×109/L) 15.75±5.90 14.79±4.50 Hb/(g/L) 105.00±12.10 112.00±15.10 CRP/(μg/L) 55.10±30.20 60.10±40.60 住院时间/d 4.35±1.60 3.78±1.30 WBC: 白细胞计数; Hb: 血红蛋白; CRP: C反应蛋白。
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