紧急剖宫产决策与安全边界:审视"5分钟"法则OA
Decision-making and safety boundaries in emergency cesarean section:examining the"5-minute"rule
随着高危孕产妇比例攀升,产房急救压力日益增加,国内诸多机构引入了"5分钟紧急剖宫产"或"决定手术至胎儿娩出时间(DDI)≤30min"作为质量考核核心指标.文章通过审视紧急剖宫产的时效法则,探讨其科学边界与潜在风险."5分钟法则"原型仅适用于濒死期剖宫产,不宜盲目泛化.目前尚无高质量证据证明DDI延迟至30 min以上与胎儿神经系统发育不良结局直接相关,且过度追求短时限可能导致母体围术期风险上升.因此,产房管理应摒弃"一刀切"的教条,建立动态分层的个体化DDI目标,引入结局导向的复合质量指标,实现时间效益与母儿安全的科学平衡.
With the proportion of high-risk pregnant women rising,the pressure on delivery units to provide emergency care is increasing.Consequently,many institutions in China have adopted the'5-minute emergency caesarean section'or'DDI ≤ 30 minutes' as core indicators for quality assessment.By examining the time-based rules for emergency caesarean sections,this article explores their scientific limitations and potential risks.The original'5-minute rule'is applicable only to caesarean sections performed during the terminal phase of labour and should not be blindly generalised.Currently,there is no high-quality evidence demonstrating a direct link between a DDI exceeding 30 minutes and adverse outcomes of fetal neurological development;moreover,an excessive focus on short time limits may lead to increased perioperative risks for the mother.Therefore,delivery room management should abandon the'one-size-fits-all'approach and establish dynamic,tiered,and individualised DDI targets instead,whilst introducing outcome-oriented composite quality indicators to achieve a scientific balance between time efficiency and maternal and neonatal safety.
赵诚;赵扬玉
北京大学第三医院妇产科国家妇产疾病临床医学研究中心国家产科专业医疗质量控制中心,北京 100191北京大学第三医院妇产科国家妇产疾病临床医学研究中心国家产科专业医疗质量控制中心,北京 100191
医药卫生
紧急剖宫产决定手术至胎儿娩出时间产房安全管理
emergency caesarean sectiondecision-to-delivery intervalsafety management in the delivery room
《中国实用妇科与产科杂志》 2026 (4)
410-413,4
首都卫生发展科研专项(首发2024-1-4094)北京大学第三医院临床重点项目(BYSYZD2022008) Capital Health Development Research Program(2024-1-4094)Key Clinical Project of Peking University Third Hospital(BYSYZD2022008)
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