产科肛门括约肌损伤的危险因素分析

Analysis of Risk Factors for Anal Sphincter Injury in Obstetrics

摘要: 目的：了解国内外产科肛门括约肌损伤危险因素研究进展，为进一步制定针对性防治策略提供参考。方法：对国内外相关文献进行检索，提取主题，分别从产妇、胎儿、助产士、产时操作、分娩方式等5个方面总结归纳产科肛门括约肌损伤危险因素。结果：综述发现，初产妇、产妇的生育年龄、体重指数、种族、孕妇的生活环境及社会地位、分娩时的情绪状态、既往OASI史、巨大儿、既往损伤史、助产士年资、器械助产、第2产程的延长、中线会阴切开术、孕产妇分娩时的体位(例如截石位﹑蹲坐)等是其危险因素。结论：临床医师及助产士通过及时准确识别孕产妇可改变危险因素，并制定针对性干预措施对其一级预防至关重要，未来可结合我国国情，构建本土化肛门括约肌损伤风险预警模型，并制定针对性干预措施，从根源防治，减少不良分娩结局发生。

Abstract: Objective: To understand the research progress of risk factors of obstetric anal sphincter injury at home and abroad, and to provide reference for further development of targeted prevention and treatment strategies. Methods: The relevant literature at home and abroad was searched, the theme was extracted, and the risk factors of obstetric anal sphincter injury were summarized from 5 aspects, such as parturient, fetus, midwife, intrapartum operation and delivery mode. The results review found that risk factors include the age of primipara, age of childbearing, body mass index, ethnicity, living environment and social status of pregnant women, emotional state at delivery, pre-vious history of OASI, macrosomia, previous history of injury, midwife’s experience, instrumental assistance, extension of the second stage of labor, midline episiotomy, and position of pregnant women during delivery (e.g. lithotomy, squatting). Conclusion: It is very important for clinicians and midwives to timely and accurately identify the risk factors that can be modified for pregnant wom-en and formulate targeted intervention measures for their primary prevention. In the future, based on China’s national conditions, a localized anal sphincter injury risk warning model can be built, and targeted intervention measures can be formulated to prevent and control the root causes and re-duce adverse birth outcomes.