正面助产法接生临床效果评价

The positive midwifery law receives the clinical effect to appraise

目的：研究正面助产法接生在临床分娩中的实际效果。方法：当初产妇宫口全开、经产妇宫口扩张4cm且宫缩规律有力时，将产妇送至分娩室平卧在全自动多功能分娩台上，根据病情采用不同的分娩体住，共有仰卧位、坐位、侧卧住、半卧蹲住、匍匐住5种分娩体位。产包放置于另外的推车上，当胎头拔露使阴唇后联合紧张时，开始保护会阴。方法是：在会阴部铺盖消毒巾，助产者正面面对产妇会阴，肘关节在自身肋骨或髂骨上为支撑点，右手握拳利用大鱼际肌及腕部之力顶住会阴部，每当宫缩时应向上向内方托压。结果：两组助产者疲劳发生率比较，研究组为46％，对照组为94％，经统计学处理，X2=119．75，P〈0．001，差异有非常显著性；对照组有疲劳者较研究组有疲劳者疲劳程度严重，具有明显情境特异性。研究组第二产程时间为30±20min，对照组为50±35min，t=7．43，P〈0．001，差异有非常显著性意义；研究组新生儿窒息的发生率为7．5％，对照组为14％，经统计学处理，X2=4．40，P〈0．05，差异有显著性意义；研究组产后2h平均出血量为185±65ml，对照组为220±75ml，t=4．99，P〈0．001，差异有非常显著性意义；研究组会阴侧切的发生率为76．5％，对照组为91％，t=15．44，P〈0．001，差异有非常显著性意义；两组会阴侧切缝合时间比较，研究组会阴侧切缝合时间为25±10min，对照组为35±15min；t=7．87，P〈0．001，差异有非常显著性意义，研究组会阴侧切缝合时间较对照组明显缩短。“三早”（早接触、早吸吮、早开奶）成功率100％，对照组为85％；X2=30．31，P〈0．001，差异有非常显著性意义。结论：正面助产法接生能有效地提高助产质量，降低助产者的疲劳感，提高了助产工作效率，是一种十分实用的很有临床推广价值的较为科学的接生方法。

Objective：The research positive midwifery law receives in the clinical childbirth the actual effect. Methods： Initially parturient woman＇s palace mouth all opened,expands after the parturient woman palace mouth when 4cm also the palace shrank the rule powerfully,the parturient woman delivers to the natuary horizontally on completely automatic multi-purpose childbirth Taiwan,used the different childbirth body posture according to the condition, altogether had the supine decubitus,the seat, the side decubitus,partly lies squats the position,crawls the position 5 kind of childbirth body posture. The midwife＇s kit lays aside on other cart, after embryo dials the dew to cause the lip of vulva unites intensely, starts to protect the perineum. The method is：In meets the genitals bedding disinfection turban,midwifery frontage faces the parturient woman perineum, the elbow joint in own rib or qia on the bone is the center of resistance, the right hand makes a fist uses the wrist department strength of the big fish border muscle and withstands meets the genitals, when the palace shrinks should the upward inward side backing pressure, Results： Two group of mid- wifery weary formation rate comparison, the study team is 46 %, the control group is 94 %, after statistics processing, X^2= 119.75, P 0.00l ,the difference has the unusual significance; The control group has the weariness to compare the study team to have the weariness weary degree to be serious,has the obvious situation specificity. The study team second course of childbirth time is 30 ±20 min,the control group is 50±35 min,t= 7.43, P =0. 001, the difference has the unusual significance significance; The study team newborns suffocate the formation rate is 7.50%, the control group is 14 % ,after statistics processing,X2=4. 40,P 〈 0. 05, the difference has the significance significance; The study team post--natal 2 h average hemorl：hage quantity is 185 ±65 ml,the control group is 220 ±75ml,t =4.99,P 〈 0. 001,the difference has the unusual significance significance; The study team perineum lateral section formation rate is 76.5 %, the control group is 91 %, t=15.44, P 〈 0. 001, the difference has the unusual significance significance; Two group of perineum lateral sections suture the time comparison, the study team perineum lateral section suture the time for 25±10 rain, the control group for 35± 15 rain ; t = 7.87, P 〈 0.001, the difference has the unusual significance significance, the study team perineum lateral section sutures the time to compare the control group obvious reduction. ＂three morning＂ （early to contact, to suck, opens milk early early） the success ratio 100~/00,the control group is 85~;X2：30.31,P ~ 0. 001,The difference has the unusual significance significance. Conclusion： The positive midwifery law receives can improve the midwifery quality effectively, reduces the midwifery weary feeling, enhanced the midwifery working efficiency,is one kind extremely practical has the clinical promoted value more scientific to receive the method very much.