阶段性管理缓解初产妇第一产程急性疼痛的效果评价

Effectiveness evaluation of stage management to reduce the acute pain in the first stage of labor

目的：通过阶段性管理深入研究评价规范化疼痛管理和互替疗法减轻初产妇疼痛的效果，并探索增进舒适支持策略。方法选取门诊定期产检并在孕妇学校上课的60名产妇作为研究对象，由研究者进行产时管理；临产后按照随机数字表法将产妇分为对照组和观察组各30人。对照组第一产程常规护理，观察组按照规范化疼痛管理和替代经验、治疗性按摩、音乐冥想及产球互替的方法进行护理。采用长海痛尺评估产妇的疼痛程度，视觉模拟评分法（ VAS）测评产妇的情绪、舒适度；将两组产妇干预后的疼痛情况、情绪变化及舒适度进行比较。结果观察组产妇疼痛程度轻度者12人（40．00％），中度者17人（56．67％），重度者1人（3．33％）；对照组产妇疼痛程度轻度者5人（16．67％），中度者21人（70．00％），重度者4人（13．33％），两组比较，差异有统计学意义（U＝2．235，P＝0．025）。观察组产妇轻微不适者22人（73．33％），中度不适者8人（26．67％），无重度不适者；对照组产妇轻微不适者10人（33．33％），中度不适者17人（56．67％），重度不适者3人（10．00％），两组比较，差异有统计学意义（U＝3．222，P＝0．001）。观察组产妇的情绪反应与对照组比较，差异无统计学意义（U＝0．800，P＝0．424）。结论阶段性管理能显著减轻初产妇产时的疼痛感并提高舒适感。

Objective Using the stage management to evaluate the normalized pain management and to alleviate pain of primipara during delivery and improve comfort .Methods Sixty pregnant women were selected and were divided into the control group and the observation group , each with 30 cases.The control group was given the usual care during the first stage of delivery , while the observation group was given a set of normalized pain management and alternative experiences of intervention , therapeutic massage , meditation with music and birth ball.The numerical rating scale （NRS） and visual analog score （VAS） were used to assess the degree of pain, emotions and comfort feelings .Then, the degree of pain and changes of emotions and comfort were compared between groups .Results Within the observation group , 12 primipara （ 40.00%） had mild pain, 17 primipara （56.67%） had moderate pain, 1 primipara （3.33%） had severe pain.Within the control group, 5 primipara （16.67%） had mild pain, 21 primipara （70.00%） had moderate pain, 4 primipara （13.33%） had severe pain.There was a significant difference between groups （U =2.235, P =0.025）.Within the observation group, 22 primipara （73.33%） had mild discomfort, 8 primipara （26.67%） had moderate discomfort.Within the control group, 10 primipara （33.33%） had mild discomfort, 17 primipara （56.67%） had moderate discomfort , 3 primipara （ 10 .00%） had severe discomfort .There was a significant difference between groups （U=3.222, P=0.001）.There was no significant difference in the emotions between groups （U=0.800,P=0.424）.Conclusions The stage management can significantly reduce the pain of primipara during delivery and improve their comfort .