探讨西安市孕产妇住院时间的影响因素。

选择2015年12月至2016年12月，于西安交通大学第一附属医院产科住院分娩或治疗的3 421例孕产妇为研究对象。采用回顾性分析方法，采集孕产妇年龄、民族，以及本次妊娠住院时间、住院次数、医疗费用支付方式、分娩方式、就诊季节、手术级别、是否由其他科室转入产科病房、妊娠期并发症、围生儿妊娠结局等临床资料。2组孕产妇住院时间比较，采用成组t检验，3组比较，采用单因素方差分析。采用多重线性逐步回归分析法，对孕产妇住院时间影响因素进行多因素分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。

①本研究3 421例孕产妇的住院时间为(6.4±3.0)d，生育年龄为(29.5±3.9)岁，高龄(≥35岁)产妇占11.0%(375/3 421)。②对孕产妇住院时间影响因素的单因素分析结果显示，不同年龄(<35岁与≥35岁)，以及本次妊娠住院次数(1次与≥2次)，医疗费用支付方式(全自费、新型农村合作医疗保险、城镇居民基本医疗保险、城镇职工基本医疗保险)，分娩方式(自然分娩、产钳助产、剖宫产术分娩)及手术级别(治疗性操作或未进行手术，一、二、三级手术)，是否由其他科室转入产科病房，是否有妊娠期并发症，围生儿妊娠结局为不良与良好孕产妇住院时间比较，差异均有统计学意义(t＝－3.34、－2.24，F＝15.46、268.81、259.68，t＝－7.58、－13.57、－13.82；P<0.05)。③对孕产妇住院时间影响因素进行多重线性逐步回归分析的结果显示，本次妊娠医疗费用支付费方式为全自费(β＝0.08，95%CI：0.01～0.16，P＝0.035)或新型农村合作医疗保险(β＝0.32，95%CI：0.06～0.59，P＝0.018)，分娩方式为自然分娩(β＝0.29，95%CI：0.04～0.54，P＝0.026)，手术级别为治疗性操作或未进行手术(β＝0.95，95%CI：0.71～1.19，P<0.001)或一级手术(β＝－0.47，95%CI：－0.79～－0.15，P＝0.004)，住院次数≥2次(β＝0.26，95%CI：0.01～0.51，P＝0.043)，有妊娠期并发症(β＝0.76，95%CI：0.58～0.95，P<0.001)，围生儿妊娠结局不良(β＝0.80，95%CI：0.58～1.02，P<0.001)，以及由其他科室转入产科病房(β＝6.55，95%CI：4.32～8.77，P<0.001)，均为孕产妇住院时间的影响因素。

西安市孕产妇住院时间，可能受医疗费用支付方式、分娩方式、手术级别、妊娠期并发症、围生儿妊娠结局、由其他科室转入产科病房等多种因素的影响。临床应当采取针对性措施，缩短孕产妇住院时间，减轻医院负担，提高医疗资源的使用效率。

To discuss the influence factors of length of hospital stay of pregnant women in Xi′an.

From December 2015 to December 2016, a total of 3 421 cases of pregnant women who were delivered or treated in the First Affiliated Hospital of Xi′an Jiaotong University were selected as research subjects. Then the patients′ maternal age, nationality, times of hospitalization, and the clinical data of this pregnancy, such as length of hospital stay, payment methods of medical care costs, modes of delivery, the seasons of operation, operation levels, whether transferring from other department into maternity ward or not, pregnancy complications, fetal pregnancy outcomes and so on were collected by retrospective method. Idependent-samples t test and one-way ANOVA were used to compare the length of hospital stay of pregnant women between two groups and three groups, respectively. Multiple linear stepwise regression analysis was used to analyze the influence factors of length of hospital stay of pregnant women. The procedure in this study was in line with the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

①The length of hospital stay of 3 421 cases of pregnant women was (6.4±3.0) d. The maternal age was (29.5±3.9) years old, and the elderly women (≥ 35 years old) accounted for 11.0% (375/3 421). ②Univariate analysis of the factors influencing the length of hospital stay of pregnant women showed that there were significant differences in the length of hospital stay of pregnant women with different ages (<35 years old and ≥ 35 years old), different times of hospitalization (1 time and ≥2 times), and different payment methods of medical care costs (self-paying, new rural cooperative medical insurance, urban residents basic medical insurance, urban workers basic medical insurance), different delivery modes (spontaneous delivery, forceps delivery, caesarean section), different operation levels (therapeutic or without operation, first-level operation, second-level operation, third-level operation), whether transferring from other department into maternity ward or not, combined with pregnancy complications or not, and different fetal pregnancy outcomes (poor and good) of this pregnancy, and all the differences were statistically significant (t=-3.34, -2.24; F=15.46, 268.81, 259.68; t=-7.58, -13.57, -13.82; all P<0.05). ③Multiple linear stepwise regression analysis results showed that self-paying (β=0.08, 95%CI: 0.01-0.16, P=0.035) or new rural cooperative medical insurance (β=0.32, 95%CI: 0.06-0.59, P=0.018), spontaneous delivery (β=0.29, 95%CI: 0.04-0.54, P=0.026), therapeutic or without operation (β=0.95, 95%CI: 0.71-1.19, P<0.001) or first-level operation (β=-0.47, 95%CI: -0.79--0.15, P=0.004), ≥ 2 times of hospitalization (β=0.26, 95%CI: 0.01-0.51, P=0.043), pregnancy complications (β=0.76, 95%CI: 0.58-0.95, P<0.001), and transferring from other department into maternity ward (β=6.55, 95%CI: 4.32-8.77, P<0.001) of this pregnancy all were the influence factors of length of hospital stay in 3 421 cases of pregnant women.

The length of hospital stay of pregnant women in Xi′an is influenced by payment methods of medical care costs, modes of delivery, operation levels, pregnancy complications, fetal pregnancy outcomes and transferring from other department into maternity ward and so on. In clinical, targeted measures should be taken to shorten the average length of hospital stay, also to relieve the burden on the hospital and improve the efficiency of the usage of medical resources.