无保护会阴接生联合会阴阻滞麻醉用于自然分娩的临床分析
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摘要
目的研究无保护会阴接生联合会阴阻滞麻醉对自然分娩的临床价值,为产妇分娩的方式选取提供参考。方法随机选择2017年6月～2018年6月我院接收的4803例产妇,按随机数字表法,将其分为两组,对照组采用常规的方式生产,于宫口开全后平卧位,用常规的保护会阴方法接产;观察组采取无保护会阴接生配合会阴阻滞麻醉的方法生产。比较两组的产程、出血量、产妇会阴和新生儿的情况等,统计观察组体位的选取种类。结果两组第一产程和出血量相近,差异无统计学意义(P> 0.05),观察组的第二产程明显少于对照组,差异有统计学意义(P <0.05),观察组新生儿Apgar评分要优于对照组(P <0.05)。观察组的会阴疼痛、会阴侧切者比例较少,而会阴完整、Ⅰ度撕裂者的比例较多,与对照组比较差异有统计学意义(P <0.05);两组均无会阴Ⅲ度撕裂伤,在会阴Ⅱ度撕裂伤的比例上也相近(P> 0.05)。观察组采取半坐位1123例(46.8%),侧卧位641例(26.7%),中途有体位更换480例(20.0%),站位31例(1.3%),蹲位127例(5.3%)。结论对足月单胎行自然分娩的产妇,无保护的会阴接生联合会阴阻滞麻醉可以减少分娩不适及产后出血,减少会阴损伤,值得推广。
Objective To study clinical values of unprotected perineum delivery combined with perineum block anesthesia in natural deliveryand to provide references for the choice of maternal delivery. Methods 4803 parturient women who were admitted to our hospital from June 2017 to June 2018 were randomly selected.According to random number table method,they were divided into two groups.Parturient women in the control group adopted the conventional way of delivery.They lay down in the supine position after the opening of theuterine orificeand delivered the baby with the conventional method of protecting the perineum.The observation group adopted unprotected perineum delivery combined with perineum block anesthesia.The stage of labors, blood loss,perineum condition and neonatal status were compared between the two groups.The types of position selection of the observation group were recorded. Results The first stage of labor and blood loss were similar in the two groups,and the difference was not statistically significant(P > 0.05).The second stage of labor in the observation group was significantly less than that in the control group,and the difference was statistically significant(P < 0.05).The Apgar score of the newborns in the observation group was better than that of the control group(P < 0.05).Cases of perineal pain and lateral episiotomy were less in the observation group while cases of perineal integrity and grade Ⅰ lacerations were more.The difference between the observation group and the control group was statistically significant(P < 0.05).There was no perineallacerationof Ⅲ degree in both groups, and the proportion of perineallacerations of Ⅱ degree was similar(P > 0.05).In the observation group, 1123 cases(46.8%) were in semi-sitting position,641 cases(26.7%) were in lateral lying position,480 cases(20.0%) were of position change,31 cases(1.3%) were in standing position and 127 cases(5.3%) were in squatting position. Conclusion Forparturient womenwith singleton term who undergo natural delivery,unprotected perineum delivery combined with perineum block anesthesia can reduce childbirth discomfort,postpartum hemorrhage andperineal injury,which is worthy of promotion.
Objective To study clinical values of unprotected perineum delivery combined with perineum block anesthesia in natural deliveryand to provide references for the choice of maternal delivery. Methods 4803 parturient women who were admitted to our hospital from June 2017 to June 2018 were randomly selected.According to random number table method,they were divided into two groups.Parturient women in the control group adopted the conventional way of delivery.They lay down in the supine position after the opening of theuterine orificeand delivered the baby with the conventional method of protecting the perineum.The observation group adopted unprotected perineum delivery combined with perineum block anesthesia.The stage of labors, blood loss,perineum condition and neonatal status were compared between the two groups.The types of position selection of the observation group were recorded. Results The first stage of labor and blood loss were similar in the two groups,and the difference was not statistically significant(P > 0.05).The second stage of labor in the observation group was significantly less than that in the control group,and the difference was statistically significant(P < 0.05).The Apgar score of the newborns in the observation group was better than that of the control group(P < 0.05).Cases of perineal pain and lateral episiotomy were less in the observation group while cases of perineal integrity and grade Ⅰ lacerations were more.The difference between the observation group and the control group was statistically significant(P < 0.05).There was no perineallacerationof Ⅲ degree in both groups, and the proportion of perineallacerations of Ⅱ degree was similar(P > 0.05).In the observation group, 1123 cases(46.8%) were in semi-sitting position,641 cases(26.7%) were in lateral lying position,480 cases(20.0%) were of position change,31 cases(1.3%) were in standing position and 127 cases(5.3%) were in squatting position. Conclusion Forparturient womenwith singleton term who undergo natural delivery,unprotected perineum delivery combined with perineum block anesthesia can reduce childbirth discomfort,postpartum hemorrhage andperineal injury,which is worthy of promotion.
引文
[1]姚尚龙,武庆平.中国产科麻醉现状及挑战[J].临床麻醉学杂志,2016,32(8):734-737.
[2]石慧娟,李科莲,刘冬艳,等.侧卧与跪趴体位联合无保护会阴接生在自然分娩的临床效果研究[J].实用医学杂志,2018,34(5):875-876.
[3]鲍静影,汪洋,刘颖,等.瑞芬太尼联合会阴阻滞用于分娩镇痛的临床探讨[J].东南大学学报:医学版,2017,36(4):599-602.
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[6]高倩,史宇晖,曾庆奇,等.湖南省自然分娩健康促进干预对婴儿母亲分娩方式选择影响[J].中国公共卫生,2017,33(4):618-621.
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[8]王智慧,陈文殊,李宇,等.硬膜外阻滞分娩镇痛下第二产程时长对新生儿结局的影响[J].现代妇产科进展,2017,26(3):219-221.
[9]胡静,肖红,邹颖,等.无保护会阴分娩技术用于初产妇会阴分娩效果的Meta分析[J].中华护理杂志,2016,51(4):413-419.
[10]梁伟珍,应莉,李卫琴,等.两步法联合无保护会阴助产技术对新生儿咽下综合征发生率的影响研究[J].中华护理杂志,2018,53(2):154-157.
[11]喻茂娟.无保护分娩术在单胎初产妇分娩中的应用效果[J].中国妇幼保健,2017,32(10):2243-2245.
[12]李志萍.无保护接生技术在低危初产妇分娩中的应用[J].华夏医学,2017,30(1):61-63.
[13]徐玲娣,冯薇.无保护接生与传统接生的临床对照研究[J].中国妇产科临床杂志,2016,17(1):66-67.
[14]林明影,陈求珠.穴位按压下自由体位联合适度保护会阴对分娩结局的影响[J].中华护理杂志,2017,52(7):875-876.
[15]刘丹娜,陈勇,黄红霞,等.硬膜外阻滞麻醉镇痛对产妇分娩的影响[J].中国药房,2016,27(17):2417-2419.
[16]王莉.自然分娩的真正内涵是什么?[J].医学争鸣,2017,8(3):46-48.
[17]黄绍强.分娩镇痛目前的观点和研究进展[J].上海医学,2016,39(4):248-252.
[2]石慧娟,李科莲,刘冬艳,等.侧卧与跪趴体位联合无保护会阴接生在自然分娩的临床效果研究[J].实用医学杂志,2018,34(5):875-876.
[3]鲍静影,汪洋,刘颖,等.瑞芬太尼联合会阴阻滞用于分娩镇痛的临床探讨[J].东南大学学报:医学版,2017,36(4):599-602.
[4]孙梅玲,贺梦雅,马玉燕.无医疗干预初产妇自然分娩的妊娠结局分析[J].现代妇产科进展,2016,25(8):600-602.
[5]唐立春.无保护会阴阴道自然分娩与常规阴道分娩临床应用价值分析[J].重庆医学,2017,46(A01):347-348.
[6]高倩,史宇晖,曾庆奇,等.湖南省自然分娩健康促进干预对婴儿母亲分娩方式选择影响[J].中国公共卫生,2017,33(4):618-621.
[7]顾晓霞,于红,闵捷.无保护分娩技术在初产妇自然分娩中的应用研究[J].东南大学学报:医学版,2017,36(6):966-968.
[8]王智慧,陈文殊,李宇,等.硬膜外阻滞分娩镇痛下第二产程时长对新生儿结局的影响[J].现代妇产科进展,2017,26(3):219-221.
[9]胡静,肖红,邹颖,等.无保护会阴分娩技术用于初产妇会阴分娩效果的Meta分析[J].中华护理杂志,2016,51(4):413-419.
[10]梁伟珍,应莉,李卫琴,等.两步法联合无保护会阴助产技术对新生儿咽下综合征发生率的影响研究[J].中华护理杂志,2018,53(2):154-157.
[11]喻茂娟.无保护分娩术在单胎初产妇分娩中的应用效果[J].中国妇幼保健,2017,32(10):2243-2245.
[12]李志萍.无保护接生技术在低危初产妇分娩中的应用[J].华夏医学,2017,30(1):61-63.
[13]徐玲娣,冯薇.无保护接生与传统接生的临床对照研究[J].中国妇产科临床杂志,2016,17(1):66-67.
[14]林明影,陈求珠.穴位按压下自由体位联合适度保护会阴对分娩结局的影响[J].中华护理杂志,2017,52(7):875-876.
[15]刘丹娜,陈勇,黄红霞,等.硬膜外阻滞麻醉镇痛对产妇分娩的影响[J].中国药房,2016,27(17):2417-2419.
[16]王莉.自然分娩的真正内涵是什么?[J].医学争鸣,2017,8(3):46-48.
[17]黄绍强.分娩镇痛目前的观点和研究进展[J].上海医学,2016,39(4):248-252.