新产程标准及处理的临床应用探讨

Discussion of Clinical Application of The Criteria and Manage of The New Labor

【目的】对新产程标准及处理(2014)在产科临床应用后孕产妇及新生儿的预后进行探讨。【方法】对2013年1月1日至2014年12月31日中山大学附属第三医院产科分娩的所有孕产妇相关分娩数据进行回顾性分析,根据时间将2013年1月1日至2014年7月31日,与2014年8月1日至2014年12月31日新产程标准执行前后的孕产妇分为对照组及研究组,对照组5 393例,研究组1 627例。并对两组孕产妇的剖宫产、剖宫产(内)、会阴侧/直切、会阴裂伤、新生儿转科、产钳助产、产后出血、新生儿窒息等数据进行统计、整理、分析。【结果】两组数据经比较分析,对照组剖宫产率、剖宫产率(内)、会阴侧/直切率、会阴裂伤率、新生儿转科率分别为:46.5%、16.6%、25.5%、21.0%、7.9%,研究组对应的数据分别为:36.6%、10.8%、16.7%、36.1%、9.5%,两组间差异均有统计学意义(P<0.05);对照组产钳助产率、产后出血率、新生儿窒息率(轻、重)分别为:1.9%、2.1%、4.6%(4.2%、0.4%),研究组对应的数据分别为:1.7%、1.4%、3.8%(3.7%、0.1%),两组间差异无统计学意义(P>0.05)。【结论】应用新产程标准及处理作为临床指导后剖宫产率、剖宫产率(内)、会阴侧/直切率明显降低,但新生儿转科率、会阴裂伤率增加,新产程标准及处理(2014)在临床中值得推广,但需加强医护方面的软硬件能力的提高,并且需进一步完善具体内容。

【Objective】 To discuss the prognosis of the new obstetrics labor standards and management（2014） application to？maternal and newborns. 【Methods】 A retrospective case-control analysis of the maternal who delivery during February l, 2013 to December 31, 2014 at the Third Affiliated Hospital of Sun Yat-sen University, the number of maternal who delivery during February l, 2013 to July 31, 2014 were 5393（Control group）, and during February l, 2013 to July 31, 2014 were 1627（Study group）. From both group we study the statistic and analysis all the maternal data of cesarean section, cesarean section（from labor room）,episiotomy / perineum straight cut, perineal laceration, neonatal change department, forceps delivery, postpartum hemorrhage,newborn asphyxia. 【Results】 Analysis the two groups data, the cesarean section rate, cesarean section rate（from labor room）,episiotomy / perineum straight cut rate, perineal laceration rate, neonatal change department rate of Control group were 46.5%,16.6%, 25.5%, 21.0%, 7.9%, the data of Study group were 36.6%, 10.8%, 16.7%, 36.1%, 9.5%, the differences between two groups were statistically significant（P〈0.05）; The forceps delivery rate, postpartum hemorrhage rate, asphyxia rate（mild, severe）of Control group were： 1.9%, 2.1%, 4.6%（4.2%, 0.4%）, the data of Study group were 1.7%, 1.4%, 3.8%（3.7%, 0.1%）,between two groups does not statistically significant（P〉0.05）. 【Conclusion】 The application of the new obstetrics labor standards and management can obviously reduce the cesarean section rate, cesarean section rate（from labor room）, episiotomy / perineum straight cut rate, but the perineal laceration rate and newborn needed transfer to the neonatal department rate are increased. The new obstetrics labor standards and management are worth to be generalization, but improvement of the equipments for medical personal aspect is needed, with also a further perfection details.