第2产程应用手膝卧位对硬膜外分娩镇痛产妇的影响

Effect of the hand-and-knee position on the second stage of labor under continuous epidural block anesthesia

目的探讨第2产程应用手膝卧位对硬膜外分娩镇痛产妇的影响。方法根据随机数字表法,将1158例产妇随机分为对照组598例与观察组560例,两组产妇均采用硬膜外分娩镇痛,第1产程及第3产程两组均采用相同的分娩处理方法,第2产程对照组采用屈腿半卧位,产床床头抬高40°,配合宫缩自然用力,在截石位完成分娩;观察组采取手膝卧位15-30 min,配合宫缩自然用力,在截石位完成分娩。比较两组产妇第1产程、第2产程、第3产程及总产程时间、分娩方式、产后会阴、产后并发症发生及新生儿出生情况等。结果两组产妇第2产程及总产程时间比较,差异具有统计学意义（均P〈0.05）,观察组产妇第2产程及总产程时间明显短于对照组,两组产妇第1产程、第3产程时间比较,差异无统计学意义（均P〉0.05）;两组产妇分娩方式情况比较,差异具有统计学意义（均P〈0.05）,观察组顺产、阴道助产、剖宫产情况明显优于对照组;两组产妇产后尿潴留发生率比较,差异具有统计学意义（P〈0.05）,观察组产妇产后尿潴留发生率明显低于对照组;两组产妇产后会阴情况及出血发生率比较,差异无统计学意义（均P〉0.05）;两组新生儿产瘤、新生儿窒息发生率比较,差异无统计学意义（均P〉0.05）。结论分娩镇痛孕妇在第2产程中采用手膝卧位可缩短产程,提高顺产率,降低阴道助产率,减少产妇产后并发症,值得临床推广应用。

Objective To compare the fetal and maternal outcomes of labor undergoing epidural block anesthesia with and without using hand-and-knee position in the second stage of labor. Methods A total of 1,158 subjects were included in the study.There were 560 subjects in the study group and 598 cases in the control group. All the subjects were divided into study and control group according to the randomized numbers. Both groups underwent epidural block anesthesia and used the same labor way in stage 1 and stage 3.In the study group, the hand-and-knee position was used for 15 -30 minutes combined with uterine contractions and the delivery was done in the lithotomy position. In the control group, the gradidea took the semi-recumbent position with bent knees and bed elevated 40°, combined with uterine contractions until the delivery was done in the lithotomy position. The labor time of stage1,stage2,stage3 and all abor, labor way, perinaueum, complications and newborns were compared. Results The average time of the second stage labor and all labor in the observation group were significantly shorter than those of the control group（ P〈0.05）. The labor ways in the observation group was better than that of the control group（P〈0.05）.The incidence of postpartum urinary retention in the observation group was significantly lower than that of the control group（P〈0.05）. The differences of labor time for stage 1,stage2, perinaueum, blood loss rate,newborns ＇s tomor and neonatal asphyxia between two groups were not statistically significant（ P〉0.05）. Conclusions Under continuous epidural block anesthesia, the use of the hands-and-knees position in the second stage of labor can reduce the incidence of operative delivery, shorten the labor process, and reduce maternal complications. The method is worthy of promotion.