产时综合性干预在头位足月分娩中的应用

Application of comprehensive intervention during intrapartum period in term delivery of head position

目的:探讨产时综合性干预在头位足月分娩中的效果。方法:选择2008年1月～2011年10月无高危因素的单胎头位足月待产初产妇600例,随机抽签分为研究组和对照组各300例。研究组实行产时综合性干预,对照组实行自然分娩和常规产科护理,对比分析两组的临床效果。结果:①临产时间:研究组和对照组分别为(60.00±12.23)min和(720.00±42.12)min;②各产程时间:研究组和对照组第一产程分别为(425.05±29.56)min和(552.12±22.20)min,第二产程分别为(50.00±15.03)min和(70.00±21.12.)min,第三产程分别为(8.25±3.03)min和(15.35±5.15)min,总产程分别为(510.30±47.62)min和(637.47±48.47)min;③平均住院时间:研究组和对照组分别为(4.12±1.51)天和(7.13±2.22)天;④日间分娩率:研究组和对照组分别为95.00%(285/300)和75.00%(225/300);⑤阴道分娩率:研究组和对照组分别为85.00%(255/300)和70.00%(210/300),其中阴道手术率研究组和对照组分别为5.33%(16/300)和10.00%(30/300),阴道顺产率研究组和对照组分别为80.00%(240/300)和65.00%(195/300);⑥剖宫产率:研究组和对照组分别为15.00%(45/300)和25.00%(75/300);⑦新生儿窒息率:研究组和对照组分别为5.33%(16/300)和11.67%(35/300);⑧产后出血率:研究组和对照组分别为3.00%(9/300)和6.00%(18/300);⑨分娩镇痛有效率:研究组和对照组分别为93.00%(279/300)和60.00%(180/300),两组结果相比差异均有统计学意义(P<0.05或P<0.01)。结论:头位足月分娩中进行合理的产时综合性干预能提高日间分娩率,达到计划分娩的目的,可缩短临产时间、各产程时间和住院时间,提高阴道分娩率,降低剖宫产和新生儿窒息及产后出血率,提高分娩镇痛有效率。

Objective： To explore the effect of comprehensive intervention during intrapartum period on term delivery of head posi- tion. Methods： A total of 600 primiparous women （single pregnancy, head position, and full term） without high risk factors were selected from January 2008 to October 2011, then they were randomly divided into study group and control group after drawing lots, 300 women in each group. The women in study group received comprehensive intervention during intrapartum period, while the women in control group un- derwent spontaneous labor and routine nursing, the clinical effects in the two groups were compared. Results： The times in labor in study group and control group were （60. 00 ± 12. 23 ） minutes and （720.00 ± 42. 12） minutes, respectively; the times of the first stage of labor in study group and control group were （425.05 ± 29. 56） minutes and （552. 12± 22.20） minutes, respectively; the times of the second stage of labor in study group and control group were （50.00 ± 15.03） minutes and （70. 00 ±21.12. ） minutes, respectively; the times of the third stage of labor in study group and control group were （ 8.25 ± 3.03 ） minutes and （ 15.35 ± 5.15 ） minutes, respectively; the time of the total stage of labor in study group and control group were （ 510.30 ± 47.62） minutes and （ 637.47 ± 48.47 ） minutes, respectively ; the mean hos- pitalization times in study group and control group were （4. 12 ±1.51 ） days and （7.13±2. 22） days, respectively; the delivery rates in daytime in study group and control group were 95.00% （285/300） and 75.00% （225/300）, respectively; the vaginal delivery rates in study group and control group were 85.00% （255/300） and 70. 00% （210/300）, respectively; the vaginal operation rates in study group and control group were 5.33% （16/300） and 10.00% （30/300）, respectively; the spontaneous vaginal delivery rates in study group and control group were 80. 00% （240/300） and 65.00% （195/300）, respectively; the rates of cesarean section in study group and control group were 15.00% （45/300） and 25.00% （75/300）, respectively; the incidences of neonatal asphyxia in study group and control group were 5.33% （16/300） and 11.67% （35/300）, respectively; the incidences of postpartum hemorrhage in study group and control group were 3.00% （9/300） and 6.00% （18/300）, respectively; the effective rates of labor analgesia in study group and control group were 93.00% （279/300） and 60. 00% （ 180/300）, respectively. There was statistically significant difference in the above - mentioned indexes between the two groups （P 〈 0.05 or P 〈 0. 01 ） . Conclusion： Reasonable comprehensive intervention during intrapartum period for term delivery of head position can improve the delivery rate in daytime, achieve the goal of programmed delivery, which earl shorten the time in la-bor, the times of the first, the second, and the third stages of labor, and the hospitalization time, improve vaginal delivery rate, reduce ce- sarean section rate, the incidences of neonatal asphyxia and postpartum hemorrhage, and improve the effective rate of labor analgesia.