气囊助产术改善阴道分娩质量的临床价值

The clinical value of gasbag midwifery skill in improving vaginal delivery quality

目的探讨气囊助产术对改善阴道分娩质量的临床价值。方法将符合相关条件的1238名产妇随机分为观察组和对照组。观察组除临产后在宫口扩张2～4cm时行双扩法气囊助产术外,其它产科处理措施与对照组相同。结果观察组第一产程(7.16±2.13)h、第二产程(0.59±0.24)h和总产程(7.89±3.58)h短于对照组(9.86±3.05)h、(0.84±0.56)h、(10.88±3.15)h(t=3.01、2.16、2.56,P<0.01、P<0.05、P<0.05);自然分娩率(79.03%)高于对照组(63.75%)(χ2=34.95,P<0.01);产钳助娩率(10.81%)和剖宫产率(10.16%)低于对照组(22.33%、13.92%)(χ2=30.31、4.34,P<0.01、P<0.05);观察组产后2h内阴道出血量(252.59±53.96)ml和产后出血发生率(1.26%)低于对照组(281.04±83.87)ml、3.57%(u=2.19、χ2=5.68,均P<0.05);胎儿窘迫发生率(4.35%)和使用缩宫素催产率(14.52%)低于对照组(10.03%、26.86%)(χ2=15.68、28.44,均P<0.01);观察组新生儿窒息率(0.65%)和软产道损伤发生率(3.05%)与对照组(0.81%、3.01%)相比差异无统计学意义(χ2=0.11、0.0018,均P>0.05)。结论气囊助产术能显著缩短产程,提高阴道自然分娩率,降低手术产率,减少阴道出血量,降低胎儿窘迫率和缩宫素催产率,是一种简便、安全、有效、适宜的现代助产技术,对改善阴道分娩质量具有重要意义,值得推广。

Objective To investigate the clinical value of gasbag midwifery skill in improving vaginal delivery quality. Methods Total 1238 primiparas with various conditions were randomly divided into the gasbag group and the control group. The gasbag group was given the same obstetrical treatments as that in the control group, but gasbag midwifery skill was used twice when the cervix was dilated 2cm～4cm in labor. Results The time of first stage, second stage and total delivery process in the gasbag group was shorter than those in the control one (P<0.01, P<0.05, P<0.05). The natural delivery rate in the gasbag group was higher than that in the control one. The forceps delivery rate and the cesarean section rate were lower than those in the control one (P<0.01, P<0.01, P<0.05). The amount of vaginal bleeding within two hours after delivery and the rate of postpartum hemorrhage was less than those in the control one (P<0.05, P<0.05). The rate of fetal distress and rate of using pitocin in the gasbag group were lower than those in the control one (P<0.01, P<0.01). The rate of maternal and fetal complications such as neonatal asphyxia and soft labor canal injury had no marked differences in the two groups. Conclusion The gasbag midwifery skill is a simple, safe, effective procedure to improve vaginal delivery quality.