导乐陪伴结合分娩镇痛对母儿结局的影响

Effect of Doula accompany with delivery analgesia on perinatal outcomes

目的探讨导乐陪伴结合椎管内麻醉分娩镇痛对阴道分娩的影响。方法将2014年4月至2016年2月在铜陵市妇幼保健院分娩的249例正常足月初产妇随机分成四组:无导乐无镇痛69例作为常规分娩组,无导乐仅镇痛65例作为镇痛组,无镇痛仅导乐60例作为导乐组,导乐陪伴结合分娩镇痛55例作为导乐+镇痛组,分别收集四组产妇的镇痛效果、产程时间、最终分娩方式、分娩后2小时出血量及新生儿Apgar评分资料。结果导乐+镇痛组、导乐组、镇痛组、常规分娩组视觉模拟评分(VAS)分别为,1(0,1)、4(3,5)、2(1,3)、9(7,10);第一产程时间分别为:(415.56±122.08)min、(447.24±173.02)min、(451.79±201.69)min、(517.98±186.74)min;第二产程时间分别为(38.73±16.29)min、(46.29±24.28)min、(49.62±29.75)min、(55.11±27.81)min。导乐+镇痛组产妇镇痛效果优于其他组,差异有统计学意义(H=147.64,P<0.01),且第一产程时间、第二产程时间均优于其他组,差异有统计学意义(F值分别为2.81、3.38,均P<0.05);四组产妇最终分娩方式(χ~2=5.32,P>0.05)、分娩后2小时出血量(F=0.27,P>0.05)、新生儿Apgar评分资料比较(F值分别为0.61、0.00,均P>0.05),差异无统计学意义。结论导乐陪伴结合椎管内麻醉分娩镇痛可以显著减轻产妇分娩带来的痛苦,降低产程时间,提高分娩质量。

Objective To investigate the effect of Doula accompany with delivery analgesia on vaginal delivery. Methods Totally 249full-term primiparas delivering in Tongling Woman and Child Health Care Hospital during the period of April 2014 to February 2016 were randomly divided into four groups,of whom 69 cases without Doula or analgesia were regarded as routine delivery group,65 cases with only analgesic as analgesia group,60 cases with only Doula as Doula group,55 cases with both Doula and analgesia as Doula accompany with delivery analgesia group. Analgesia effect,delivery time,delivery mode,two hours postpartum hemorrhage and neonatal score were collected for four groups. Results Visual analogue scale（ VAS） of Doula accompany with delivery analgesia group,Doula group,analgesia group and routine delivery group was 1（ 0,1）,4（ 3,5）,2（ 1,3） and 9（ 7,10）,respectively. The first stage of labor of each group was415. 56 ± 122. 08 min,447. 24 ± 173. 02 min,451. 79 ± 201. 69 min and 517. 98 ± 186. 74 min,respectively. The second stage of labor of each group was 38. 73 ± 16. 29 min,46. 29 ± 24. 28 min,49. 62 ± 29. 75 min and 55. 11 ± 27. 81 min,respectively. Analgesia effect of Doula accompany with delivery analgesia group was significantly better than that of other groups（ H = 147. 64,P 〈0. 01）,and the first and second stage of labor of the group were superior to those of the other groups with statistical significance（ F value was 2. 81 and 3. 38,respectively,both P 〈0. 05）. There were no significant differences in delivery mode（ χ2= 5. 32,P 〉0. 05）,two hours postpartum hemorrhage（ F = 0. 27,P〉 0. 05） and neonatal Apgar score（ F value was 0. 61 and 0. 00,respectively,both P 〉0. 05） among four groups. Conclusion Doula accompany with delivery analgesia could significantly reduce maternal pain,reduce labor stage and improve the quality of delivery.