改变产妇体位对促进产程进展的临床探讨

Clinical discussion for changing the position of parturient to promote birth process

目的探讨产妇在第一产程和第二产程各采取不同分娩体位对促进产程进展和自然分娩的效果。方法选择孕37～41周头位分娩初产妇152例，随机分为2组，观察组（80例）第一产程可选择行、走、蹲、侧卧、半卧等自主体位；第二产程采取半卧位，胎头拨露时采取截石位。对照组（72例）产妇第一产程采取卧位（平卧、侧卧交替），第二产程采取截石位。观察2组产程进展和产妇舒适度的变化。结果观察组第一产程（361．83±58．02）min，第二产程（36．39±11．97）min，总产程（398．21±59．72）min；对照组第一产程（560．85±131．98）min，第二产程（58．11±15．44）min，总产程（618．964±139．61）min。观察组较对照组各产程时间均缩短（t值分别为12．24、9．74、12．90，P均〈0．01）。观察组产后2h下肢酸麻13例，对照组25例；观察组产后12h下肢酸麻2例，对照组10例。观察组较对照组不同时段产妇舒适度增加（X^2值分别为6．90、5．28，P〈0．01、P〈0．05）。结论第一产程自主体位及第二产程半卧位可有效缩短产程并缓解产后不适。

Objective To discuss the effect on promoting the progress of the stage of labor and the natural delivery as the parturient adopts the different delivery position in the first and the second stage of labor. Methods One hundred and fifty-two cases of delivery primiparas of cephalic presentation whose pregnancy was from 37 to 41-weeks were enrolled and divided into two groups randomly~ In the observation group （80 cases） ,the free positions of delivery like walking, squating, lateral position, half lying and others could be selected in the first stage of labor, the semi-reclining position was selected in the second stage of labor and the lithotomy position was adopted when the head was visible on vulvae gapping. The parturient in the control group （72 cases） selected the decubitus （alternation between prostration and lateral position） in the first stage of labor and the parturient selected routine lithotomy position of supine position in the second stage of labor. The progress of labor and the comfort of the parturient in the two groups were observed. Results In the observation group, time spent in the first stage and second stage were （361.83±58.02）mins and （36. 39±11.97 ）mins, and （398.21±59.72）mins in the total birth process, which were significantly shorter than those of （560. 85±131.98） mins and （ 58. 11±15.44 ） mins, and （ 618.96±139. 61 ） mins, respectively （ t = 12. 24,9. 74 and 12. 90,Ps 〈0.01 ）. There were 13 and 25 cases experienced tingle in two hours after delivery, and 2 and 10 cases in 12 hs after delivery, in the observation and control group, respectively. The comfort of parturient in the observation group was higher than that in the control group （ X^2 = 6. 90, P 〈 0. 01 ; X^2 = 5. 28, P 〈 0. 05 ） respectively. Conclusion The free position in the first stage of labor and the semi-reclining position in the second stage of labor can shorten the birth process effectively and relieve the discomfort after the delivery.