Hemminki E, Gissler M
National Research and Development Centre for Welfare and Health, Health Services Research Unit, Helsinki, Finland.
Int J Gynaecol Obstet. 1996 May;53(2):125-32. doi: 10.1016/0020-7292(95)02641-x.
To study the relationship between epidural analgesia and instrumental and non-elective cesarean delivery in the 1990s in Finland.
The data was extracted from a nationwide birth register in 1991-1993. To adjust for other factors, hospital-based analyses were made separately for different types of hospitals and in individual-based analyses logistic regression was used.
In the hospital-based analyses there was no systematic correlation between rates of epidural analgesia and operative delivery, but on the individual level there was. Comparison of hospitals with different levels of epidural rates and different types of hospitals suggests that the contradictory findings in the hospital and individual-based analyses are partly due to selection bias, and partly to different hospital policies.
The results in previous studies and our results suggest that epidural analgesia is a risk factor for an operative delivery, but not a sufficient one, and its impact is likely to be modified by other obstetric practices and interventions.
研究20世纪90年代芬兰硬膜外镇痛与器械助产及非选择性剖宫产之间的关系。
数据取自1991 - 1993年全国出生登记册。为调整其他因素，针对不同类型医院分别进行基于医院的分析，并在基于个体的分析中使用逻辑回归。
在基于医院的分析中，硬膜外镇痛率与手术分娩率之间没有系统相关性，但在个体层面上存在。对不同硬膜外镇痛率水平的医院和不同类型医院进行比较表明，基于医院和个体的分析中相互矛盾的结果部分归因于选择偏倚，部分归因于不同的医院政策。
先前研究的结果以及我们的结果表明，硬膜外镇痛是手术分娩的一个危险因素，但并非充分条件，其影响可能会被其他产科操作和干预措施所改变。
