剖宫产新生儿适宜体位临床研究

Investigation of newborn′s proper posture after partus caesareus

目的为预防剖宫产手术新生儿窒息选择新生儿适宜体位。方法选择同期择期剖宫产手术120例,新生儿娩出经手术医师初步呼吸道清洁后,安放在保暖台时立即取侧卧头略后仰位,酌情行口咽腔吸引,记录吸出液量;测量额枕径、胸径、背枕距、头肩距;以此计算出背枕及肩头角度;分别于娩出后1、5m in和出手术室时进行Apgar评分。结果额枕径(12.5±0.7),胸径(9.6±0.5),背枕距(4.2±0.5),头肩距(2.7±0.6),额枕径大于胸径(P<0.05)。新生儿娩出后85%需口咽腔吸引,9例在处理脐带过程中可见分泌物/羊水积聚于口侧腔,或经口角流出,但均未发生误吸、低氧。1m in及5m in Apgar评分均值>8分,出手术室时>9分,3例Apgar评分6～7分经口咽腔吸引、面罩加压吸氧人工辅助通气后Apgar评分>9分出手术室,所有新生儿均未作气管插管。结论侧卧头略后仰位是预防剖宫产新生儿窒息适宜体位。

Objective To select a proper posture for newborn from partus caesareus in order to prevent suffocation.Methods 120 cases of newborn from partus caesareus were selected.the respiratory tracts of the newborn were cleaned first by the operator.They were then laid on the warm platform in a posture of lying on side with head turning up a little.and sucked from their mouths and pharyngeal cavitieswhen circumstances required.The liquid quality was recorded.The distances between brow and occipital,back and occipital,head and shouders and the breast circumference were measured.From these datum the angles between back-occipital and the shoulders were calculated out.AIl these newborn were evaluated by APGAR 1 and 5 minutes after delivery by Partns caesareus respectively.Results Brow occipital distance（12.5±0.7）,breast circumference（9.6±0.5）,back occipital distance（4.2±0.5）,head shouder distance（2.7±0.6）;brow-occipital distancebreast circumference（P 0.05）.85%of the new born need suction from mouth-cavities and pharyngeal space.9 cases were seen shedding ammiotic fluid from the corners of their mouths.There was no oxygen difficient case.no wrong drawing in.APGAR score after 1 and 5 minutes were more than 8.On leaving the operation room,their score were more than 9.3cases with scores from 6~7 had got scores more than 9 after being sucked from mouth cavities and pharyngeal space combined with mask oxygen therapy.None of them,on leaving the operation room needed trache-intubation.Conclusion Lying on side with head turning up a little is a proper posture to prevent newborn baby′s suffocation.