综合干预对初产妇分娩自我效能、分娩应对及剖宫产率的影响

Effect of prenatal comprehensive intervention on childbirth self.efficacy and coping ability during labour and cesarean section rate in primipara

目的探讨以自我效能理论为基础的综合干预模式对初产妇分娩自我效能、分娩应对及剖宫产率的影响。方法2010年8—11月将93例中南大学湘雅三医院产科定期产检并待产的初产妇作为调查对象，采用随机数字法分为观察组（44例）及对照组（49例）。对照组予以常规产检及护理，观察组在此基础上给予自我效能理论为基础的产前综合干预。采用简化中文版分娩自我效能量表（CBSEI—C32）、分娩应对量表（CCB）、视觉模拟量表（VAS）对两组患者的干预效果进行评价。结果干预后观察组初产妇的分娩自我效能水平（0E．16、EE．16、CBSEI-C32总分）差值明显高于对照组[（132．55±10．77）分比（7．43±12．11）分]，[（33．61±24．23）分比（2．51±11．19）分]，[（68．77±45．35）分比（2．48±20．35）分]，两组比较，差异有统计学意义（t分别为-8．960，-7．801，-8．922；P〈0．05）；观察组自然分娩产妇应对能力得分为（52．43±1．95）分，对照组为（28．67±8．97）分，两组比较，差异有统计学意义（t=18．067，P〈0．05）；观察组自然分娩初产妇分娩疼痛感知水平低于对照组比较，差异有统计学意义（z=-4．427，P〈0．05）；在剖宫产率方面观察组也明显低于对照组（15．9％比34．7％），两组比较，差异有统计学意义（x^2=4．273，P〈0．05）。结论综合干预可提高初产妇的分娩自我效能感水平，降低初产妇对分娩疼痛的感知水平，提高分娩应对能力，降低剖宫产率。

Objective To explore the effectiveness of the efficacy-enhancing prenatal comprehensive intervention in promoting women＇ s self-efficacy for childbirth and coping ability during labour and reduce cesarean section rate in primipara. Methods This study randomly selected 93 primiparas and allocated them randomly to two groups： observational group （44 cases）and control group （49 cases ）. The patients in control group received routine prenatal examination and care while the patients in observational group received regular care and prenatal comprehensive observational based on self-efficacy theory. The CBSEI-C32 ,the CCB, the VAS are applied to assess the general situation of self-efficacy, coping ability maternal childbirth during labour capabilities and assess the degree of pain produced in labour. The data were analyzed using X2 test and t test and Mann-Whitney U test. Results Observational group reported a significantly higher level of childbirth self- efficaey during labour than the control group [ （ 132.55 ± 10.77 ） vs （7.43 ± 12.11 ） ], [ （ 33.61 ± 24.23 ） vs （2.51 ± 11.19） ], [ （68.77 ± 45.35 ） vs （2.48 ±20.35 ） ] （t = - 8. 960, - 7. 801, - 8. 922, respectively; P 〈 0. 05 ） ; The score of coping behavior in natural delivery of observational group was （ 52.43 ± 1.95 ） which was significantly higher than （28.67 ± 8.97 ） in control group. The control group produced significantly higher perception of pain compared with the observational group, the difference has statistic meaning （ Z = - 4. 427, P 〈0. 05）. The cesarean section rate of observational group（ 15.9% ） was lower the control group （34.7%） （ X2 = 4. 273, P 〈 0. 05 ）. Conclusions The comprehensive observational is effective in promoting pregnant women＇ s self-efficacy for childbirth and reducing their perceived pain, and can reduce the rate of cesarean section.