第二产程急诊剖宫产子宫下段切口入路选择及娩头力学分析

CHOICE OF UTERUS INCISION AND DYNAMIC MECHANISM OF FETAL HEAD DELIVERY DURING EMERGENCY CESAREAN SECTION IN SECOND STAGE OF LABOUR

目的评价分析第二产程急诊剖宫产子宫下段“U”形切口的入路选择及娩头力学机制。方法随机选取116例第二产程急诊剖宫产,采用子宫下段“U”形切口的娩头入路,另随机抽取80名健康医生分别测量屈指上托力(A)、屈腕上托力(B)、屈肘上托力(C),测3次以其平均值表示(-x±s)。比较三种力值大小及采用三种不同力学娩头的耗时及成功率。结果屈肘上托力明显大于屈指上托力(P<0.01)和屈腕上托力(P<0.01);采用屈肘上托力娩头平均耗时为(33.82±1.47)s,而屈指上托力及屈腕上托力分别耗时(66.81±7.63)s(P<0.001)和(48.61±5.32)s(P<0.001)。同时前者比后二者娩头成功率明显提高(100%,60%,38.71%,P<0.005)。结论第二产程急诊剖宫产子宫下段“U”形切口采用屈肘上托力娩头为最佳娩头方法,符合杠杆原理。

Objective To evaluate and analyze application of uterus ＂U＂ incision and dynamic mechanism of fetal head delivery during emergency cesarean section in second stage of labour. Methods 80 doctors who were choice at randomly and their power of bending fingers upward, bending wrist upward, bending elbow upward were measured. ＂U＂ incision was adopted in 116 cases choiced randomly during emergency cesarean section in second stage of labour. The three different dynamic values and three ways of fetal head delivery were compared and analyzed. Results The power of bending elbow upward were higher than those of bending fingers upward （P〈0. 01） ,bending wrist upward （P〈0.01）. On the other hand , the successful rates of fetal head delivery by adopting the power of bending elbow upward necessarily combined with pushing power upward through vagina by assistants were significantly higher than those of adopting the power of bending fingers upward （P〈0.005）, bending wrist upward （P〈0. 005）,and time of delivery of fetal head was shorter, Conclusion The applications of uterus ＂U＂ incision during emergency cesarean section in second stage of labour, and bending elbow upward during delivery of fetal head are feasible and highly efficient, which is easily explained by laws of pole and stick.