宫底免沙袋加压在剖宫产术后的临床效果研究

The clinical effect of pressing uterine fundus without sandbag after cesarean section

目的探讨宫底免沙袋加压在剖宫产术后的临床效果并作泌乳量调查,为剖宫产术后护理提供参考。方法回顾性分析陆军军医大学第三附属医院大坪医院2014年6月至2016年8月行剖宫产手术的产妇1 067例,按术后护理方法不同分为3组,对照组(356例)实施剖宫产后常规宫底压沙袋6 h,之后翻身随意取卧位;观察1组(356例)实施剖宫产后常规压沙袋2 h,2 h后翻身取侧卧位;观察2组(355例)实施剖宫产术后免压沙袋,每隔30 min进行1次宫底按压,每隔2 h在护士帮助下翻身。观察3组产妇术后6 h出血量、舒适度、疼痛程度、第一次肛门排气时间及24 h的泌乳量。结果 3组产后6 h出血量比较,差异无统计学意义(P>0. 05);术后6 h对照组轻度不适[128例(36. 0%)]低于观察1组和观察2组[232例(65. 2%)、286例(80. 6%)](P <0. 05);对照组轻度疼痛[203例(57. 0%)]低于观察1组和观察2组[241例(67. 7%)、277例(78. 0%)](P <0. 05);肛门排气时间对照组[(27. 3±6. 2) h]长于观察1组和观察2组[(26. 5±5. 1) h、(21. 4±4. 3) h](P <0. 05);产后24 h泌乳量为中量的对照组[112例(31. 5%)]低于观察1组和观察2组[134例(37. 6%)、168例(47. 3%)](P <0. 05)。结论剖宫产术后宫底是否压沙袋对患者术后6 h的出血量无明显影响,免沙袋加压可有效提高产妇术后6 h的舒适度,降低疼痛程度,缩短第一次肛门排气时间,增大术后24 h产妇的泌乳量。剖宫产术后免宫底沙袋加压可为产妇术后恢复提供良好帮助。

Objective To discuss the clinical effect of pressing uterine fundus without sandbag after cesarean section and investigate lactation volume,to provide reference for clinical care after cesarean section. Methods Retrospective analysis of 1 067 maternal women who underwent caesarean section from June 2014 to August 2016 in the Third Affiliated Hospital of Army Medical University,Daping Hospital. According to different nursing methods,divided them into three groups. After cesarean section,the control group( 356 cases) were given routine uterine fundus pressure by sandbags for 6 hours,then turn to take supine position freely;observation 1 group( 356 cases) were given routine uterine fundus pressure by sandbags for 2 hours,then turn to take supine position freely;observation 2 groups( 355 cases) were not given sandbags,the utero-compression was performed once every 30 minutes and turned over with the help of a nurse every 2 hours. The blood loss in 6 hours after operation,comfort,pain,first anus exhaust time,and 24 h lactation were observed in 3 groups. Result There was no statistically significant difference in bleeding volume between the3 groups at 6 hours postpartum( P > 0. 05);6 hours after operation,mild discomfort in the control group [128 cases( 36. 0 %) ]was lower than that of the observation group 1 and observation group 2 [232 cases( 65. 2 %),286 cases( 80. 6 %) ]( P < 0. 05);Mild pain in the control group [203 cases( 57. 0 %) ] was lower than that in the observation group 1 and observation group 2 [241 cases( 67. 7 %),277 cases( 78. 0 %) ]( P < 0. 05);anal exhaust time of control group [( 27. 3 ±6. 2) h]was longer than observation group 1 and observation group 2 [( 26. 5 ± 5. 1) h,( 21. 4 ± 4. 3) h]( P < 0. 05);moderate lactation volume 24 hours postpartum in the control group [112 cases( 31. 5 %) ] was less than the observation group 1 and observation group 2 [134 cases( 37. 6 %),168cases( 47. 3 %) ]( P < 0. 05). Conclusion In cesarean section,whether using sandbags pressure at the uterine fundus does not affect the blood loss volume 6 hours after surgery. Without sandbags utero-compression can effectively improve the postpartum women's comfort after 6 hours,reduce the pain and shorten the first anus exhaust time,increase the lactation amount 24 hours after surgery. The pressure of the bottom of the uterus after cesarean section can provide good help for the recovery of the postoperative women.