综合系统评估降低会阴侧切率的临床研究

Clinical study of comprehensive system assessment on reducing the rate of lateral episiotomy

目的探讨产妇分娩时进行综合系统评估对限制会阴侧切的效果。方法选择温州市中医院妇产科2015年6月至2016年12月接收的初产妇280例为研究对象,按照随机数字表法分为观察组和对照组,每组均140例,对照组采用传统产程护理,按产科传统的服务模式进行,观察组在分娩期当胎头拔露至2.5cm左右运用系统综合评估方法进行评估,≥20分时给予会阴切开,<20分时限制会阴切开,比较两组孕产妇会阴情况及母婴结局。结果对照组140例初产妇中,会阴侧切率为35.00%(49/140),会阴完整率为7.86%(11/140),会阴裂伤率为57.14%(80/140),观察组分别为22.14%(31/140)、17.14%(24/140)、60.71%(85/140),观察组会阴侧切率显著低于对照组(χ~2=6.670,P<0.05),会阴完整率显著高于对照组(χ~2=5.518,P<0.05),两组会阴裂伤率无显著性差异(χ~2=0.369,P>0.05)。两组患者产后出血量、产后6h会阴疼痛VAS比较无无显著性差异(t值分别为1.017、0.236,均P>0.05),观察组会阴疼痛VAS在产后12h、24h均显著低于对照组(t值分别为2.367、2.948,均P<0.05),且产后恢复性交时间显著低于对照组(t=3.037,P<0.05),两组患者住院时间、新生儿出生Apgar评分(1min和5min)比较无无显著性差异(t值分别为0.217、0.206,均P>0.05),新生儿头皮血肿发生率无显著性差异(χ~2=0.515,P>0.05)。结论综合系统评估可降低初产妇会阴侧切率,有助于保持会阴完整,降低并发症。

Objective To investigate the effect of comprehensive systematic assessment on limitation of lateral perineotomy during delivery.Methods Altogether 280 primiparas admitted in department of obstetrics and gynecology of Wenzhou Hospital of Traditional Chinese Medicine from June 2015 to December 2016 were selected and divided into observation group and control group according to random number table method with 140 cases in each group.Cases in the control group received traditional labor nursing, proceeded according to traditional service mode of obstetrics.Cases in the observation group were assessed with comprehensive systematic assessment when fetal head was exposed to about 2.5 cm in delivery period, and treated with episiotomy when scored 20 and above.Limitation of episiotomy was implemented when they were scored below 20.Perineum condition and maternal and neonatal outcomes of patients in two groups were compared.Results Episiotomy rate of 140 cases in the control group was 35.00% （49/140）, perineum intact rate was 7.86% （11/140） and perineal laceration rate was 57.14% （80/140）.Those in the observation group were 22.14% （31/140）, 17.14% （24/140） and 60.71% （85/140）, respectively.Episiotomy rate in the observation group was significantly lower than that in the control group （χ2=6.670, P〈0.05）, and perineum intact rate was significantly higher than that in the control group （χ2=5.518,P〈0.05）.But there was no significant difference in perineal laceration rate between two groups （χ2=0.369,P〉0.05）.Moreover, there was no significant difference in postpartum hemorrhage amount and perineal pain VAS at 6h after delivery between two groups （t value was 1.017 and 0.236, respectively, both P〉0.05）, but perineal pain VAS at 12h and 24h after delivery in the observation group were significantly lower than those in the control group （t value was 2.367 and 2.948, respectively, both P〈0.05）.Time to resume sexual intercourse after birth in the observation group was significantly shorter than that in the control group （t=3.037, P〈0.05）.There was no significant difference in length of hospital stay and neonatal Apgar score at birth （1min and 5min） between two groups （t value was 0.217 and 0.206, respectively, both P〉0.05）, and there was no significant difference in incidence of neonatal scalp hematoma between two groups （χ2=0.515, P〉0.05）.Conclusion Comprehensive systematic evaluation could reduce primipara episiotomy rate and help to keep the perineum intact and reduce complications.