产时医疗干预措施对产科质量的影响

EFFECT OF INTRAPARTUM MEDICAL INTERVENTION ON OBSTETRIC QUALITY

[目的]探讨产时医疗干预对产科质量的影响。[方法]选择2001年1月￣2004年12月阴道试产、单胎头位、无内外科疾病及产科合并症和并发症的1685例初产妇,根据是否进行一对一陪伴、分娩镇痛、会阴侧切、宫缩素催产、自由体位、肛诊分别分组比较。[结果]陪伴组阴道分娩率明显高于未陪伴组、第二产程延长、产后出血、产褥感染、胎儿窘迫、新生儿窒息、新生儿病率的发病率低于未陪伴组。镇痛组宫缩乏力率明显低于无镇痛组。自由体位组产后出血、新生儿窒息率明显低于常规平卧体位组。会阴侧切组产后出血率高于无会阴侧切组。催产组产后出血、会阴裂伤及新生儿窒息率明显高于非催产组,剖宫产率明显低于非催产组。肛诊组产后感染、新生儿窒息及新生儿吸入性肺炎高于阴道检查组。[结论]应鼓励使用陪伴分娩、分娩镇痛、自由体位分娩;控制使用会阴侧切、缩宫素催产;废除肛诊、平卧分娩,以利于降低剖宫产率,减少产时的母婴并发症,提高产科质量。

[Objective] To study the effects of intrapartum medical intervention on the obstetric quality. [Methods] Selected 1685 primiparous women from Jan.2001 to Dec.2004 who were vagina trailroduce, single-fetus, headlong and without medical, surgical diseases or obstetrical syndrome. They were respectively grouped and compared according to whether kept one company during childbearing, labor analgesia, lateral episiotomy, expedited delivery by Oxytocic Hormone. free body position and anus diagnosis. [ Results ] The vagina delivery ratio in companied group was higher than that in comparison group, the rates of prolonged second stage of labor, flooding, puerperal infection, fetal distress, apnoea neonatorum and disease incidence in companied group were lower than that in no-companied group. The uterine inertia rate in analgesia group was distinctly lower than that in non-analgesia group. The rates of flooding and apnoea neonatorum in free body position group were distinctly lower than that in decubitus body position group. The flooding rate in lateral episiotomy group was higher than that in non-lateral episiotomy group. The rates of flooding, perineal laceration and apnoea neonatorum in oxytocie group were distinctly higher than that in non-oxytocic group, the rate of abdominal delivery in oxytocic group was lower than that in non-oxvtocic group. The rates of infection after delivery, apnoea neonatorum and aspiration pneumonitis of newborn m anus diagnosis group were distinctly lower than that in vagina examination group. [ Conclusion ] Companied delivery, labor analgesia, free body position should be encouraged. Lateral episiotomy, usage of Oxytocic Hormone should be controlled. Anus diagnosis, delivery, with usual decubitus body position should be cancelled to reduce the rates of abdominal delivery, decrease the syndrome between foetus and lying-in women and improve the obstetrics quality.