分娩球辅助自由体位分娩的优势

Advantage of childbirth with ball-assisted free body position

目的 评价分娩活跃期产妇应用间苯三酚配合分娩球辅助自由体位的临床效果及安全性.方法 选取2015年6月至2016年8月在北京市海军总医院拟行经阴道分娩的152例初产妇作为研究对象.均给予80 mg间苯三酚稀释于生理盐水注射液中静脉推注.观察组采用分娩球配合自由体位助产.对照组产妇采用传统平卧或侧卧体.结果 观察组胎先露下降速度（1.09±0.22） cm/h 较对照组（0.83±0.15） cm/h快,观察组产妇第一产程时间（9.57±1.71） h、第二产程时间（35.75±8.68） min及总产程时间（11.34±1.96） h均较对照组（12.13±2.64） h、（61.21±10.03） min、（14.66±2.70） h 短,两组比较差异均有统计学意义 （t值分别为3.611、4.204、3.307、3.456,P均〈0.05）.而对照组与观察组第三产程时间分别为（8.43±1.12） min与（7.92±0.96） min ,两组比较差异无统计学意义（t=1.005,P〉0.05）.观察组阴道分娩构成比89.47 %（68/76）明显较对照组73.68 % （56/76）高,差异有统计学意义（χ2=4.514,P〈0.05）.观察组阴道助产构成比1.32 %（1/76）及剖宫产构成比9.21 %（7/76）明显较对照组5.26 %（4/76）、 21.05%（16/76）低,差异均有统计学意义（χ^2值分别为5.323、4.376,P均〈0.05）,观察组产后24 h出血量（273.12±58.23） ml,明显较对照组（385.42±70.13） ml少,两组比较差异有统计学意义（t=3.744,P〈0.05）.观察组产后出血构成比1.32 %（1/76）、尿潴留构成比2.63 %（2/76）及新生儿窒息发生构成比2.63 %（2/76）均低于对照组[5.26 %（4/76）、 10.53 %（8/76）、 9.21 %（7/76）],两组比较差异均有统计学意义 （χ^2分别为4.103、4.925、4.421,P均〈0.05）.结论 分娩球辅助自由体位分娩能够促进自然分娩,医护人员应及时更新分娩观念,提高认识,鼓励产妇配合应用间苯三酚联合自由体位分娩法.

Objective To evaluate the clinical effect and safety of intravenous administration of phloroglucinol combined with delivery of ball-assisted free position in parturient women during labor.Methods One hundred and fifty-two primiparous women who were treated by vaginal delivery from June 2015 to August 2016 in Beijing Navy General Hospital were selected as the study subjects.They were given 80 mg of phloroglucinol diluted in saline injection intravenous injection.Observation group were treated with childbirth.Control group treated with traditional supine or lateral body.Results The rate of descending of the observed group was longer than that of the control group（（1.09±0.22） cm/h vs.（0.83±0.15） cm/h）,the first labor time,the second labor time and the total labor time of the observation group were shorter than the control group（（9.57±1.71） h vs.（12.13±2.64） h,（35.75±8.68） min vs.（61.21±10.03） min,（11.34±1.96） h vs.（14.66±2.70） h）,the difference between the two groups was statistically significant（t=3.611,4.204,3.307,3.456,P〈0.05）.While the third labor time of the control group and the observation group were （8.43±1.12） min and （7.92±0.96） min,the difference between the two groups was not statistically significant（t=1.005,P〉0.05）.The percentage of vaginal delivery in the observation group was 89.47%（68/76）,significantly higher than that in the control group（73.68%（56/76））,the difference was statistically significant（χ2=4.514,P〈0.05）.The incidence of vaginal midwifery was 1.32%（1/76） and that of cesarean section was 9.21%（7/76） of observation group,significantly lower than that in control group（5.26%（4/76）,21.05% （16/76））,the difference was statistically significant（χ2=5.323,4.376,P〈0.05）.Observation group 24 h postpartum hemorrhage was （273.12±58.23） ml,significantly less than the control group（（385.42±70.13） ml）,the difference between the two groups was statistically significant（t=3.744,P〈0.05）.The observation group had postpartum hemorrhage of 1.32%（1/76）,urinary retention of 2.63%（2/76）,and the percentage of neonatal asphyxia of 2.63%（2/76）,were lower than that of the control group（5.26%（4/76）,10.53%（8/76）,9.21%（7/76））,the difference between the two groups was statistically significant（χ2=4.103,4.925,4.421,P〈0.05）.Conclusion The delivery of ball-assisted free-body delivery in active stage of delivery can promote natural childbirth.The medical staff should update the concept of delivery and raise awareness to encourage the use of phloroglucinol combined with free-body delivery.