3种会阴处理方法的临床应用与比较

Clinical application and comparison of three perineal treatment methods

目的探讨自然分娩过程中会阴不同处理方法的临床效果及应用。方法将经阴道分娩产妇700例按分娩方式随机分为3组,在胎儿娩出期采用45°侧切会阴的206例为会阴侧切组,在胎儿娩出期采用垂直切开会阴的247例为会阴直切组,在胎儿娩出期采用会阴自然撕裂方法的247例为会阴撕裂组,观察3组第二产程时间、切口损伤程度、缝合时间、术后疼痛程度、72 h活动和切口感染率。结果会阴撕裂组在切口损伤、缝合时间、疼痛分级情况、产后72 h活动度、切口甲级愈合率均优于会阴侧切组,差异有统计学意义(P<0.05)。结论会阴直切术对产妇损伤大,会阴撕裂法更符合自然分娩过程,建议使用会阴撕裂法;但在新生儿可能宫内缺氧时,为了缩短第二产程,建议行会阴侧切术。

Objective To explore the clinical effect and application of different perineal treatment methods in natural delivery. Methods Seven hundred women of vaginal delivery were randomly divided into three groups according to delivery modes ： 206 women in episiotomy group underwent 45° episiotomy during delivery of fetus, 247 women in vertical perineal incision group underwent vertical perineal incision during delivery of fetus, 247 women in perineal tear group were treated by natural perineal tear method during delivery of fetus. The time of the second stage of labor, the damage degrees of incision, suture time, postoperative pain degrees, 72-hour activities after delivery, and wound infection rates in the three groups were observed. Results The damage degree of incision, suture time, postoperative pain degree, 72-hour activity after delivery, wound infection rate in perineal tear group were statistically significantly better than those in episiotomy group （ P〈0. 05 ） . Conclusion Vertical perineal incision can induce large injury among lying-in women, perineal tear is more coincidence with the process of natural childbirth, but episiotomy is recommended to shorten the second stage of labor when the neonates are found with hypoxia.