第一产程中产妇自由体位配合导乐工具对分娩结局的影响

Influence of maternal free position combined with duole tools during the first labor stage on birth outcomes

目的 探讨产妇第一产程时采取自由体位配合导乐工具,对于分娩心理及分娩应对能力的影响,并观察妊娠结局.方法 选择2016年5～12月在温州市人民医院常规检查的正常孕妇600例,按孕妇的预产期日数奇偶数随机分为观察组和对照组,每组300例,对照组产妇在第一产程取常规仰卧体位,实验组在第一产程中采取自由体位配合导乐工具进行干预.观察两组第一产程时间,分娩方式,新生儿窒息,产后出血,产妇生殖道损伤情况,评估产妇产后2 h内填写疼痛评分,产妇分娩应对量表（CCB）和采用综合性医院焦虑抑郁量表（HAD）评估焦虑情绪.结果 观察组产妇自然分娩率和可耐受疼痛分别为90.0％（270/300）和73.7％（221/300）,高于对照组83.3％（250/300）和62.0％（186/300）,观察组产妇会阴Ⅱ度裂伤和新生儿窒息率分别为8.3％（25/300）和1.7％（5/300）,低于对照组12.3％（37/300）和4.3％（13/300）,差异有统计学意义（χ2=9.31、9.84、9.05、8.39,均P＜0.05）;观察组产妇第一产程时间和产后出血量为（10.87±3.06）h和（121.60±15.11）mL,少于对照组（11.69±2.48）h和（180.52±14.76）mL,差异有统计学意义（t=8.92,9.74,P＜0.05）;观察组产妇HAD评为（6.04±1.95）分,低于对照组（8.76±1.21）分,观察组产妇CCB评分为（49.82±7.61）分,高于对照组（45.33±6.90）分,差异有统计学意义（t=10.15、11.32,均P＜0.05）.结论产妇第一产程时采取自由体位配合导乐工具,自然分娩率、可耐受疼痛及产后应对能力显著提高,第一产程显著缩短,产后不良影响及心理焦虑状态降低.

Objective To explore the influence of maternal free position combined with duole tools during the first labor stage on birth outcomes.Methods 600 normal pregnant women who were routinely examined in our hospital from May 2016 to December 2016 were selected.They were randomly divided into observation group and control group according to the number of prenatal date of pregnant women,each group in 300 cases.The control group was taken routine supine position in the first labor stage.The observation group used free position with duole tools during the first labor stage.The maternal first labor time,delivery mode,neonatal asphyxia,postpartum hemorrhage,maternal reproductive tract injury were observed.The maternal postpartum within 2 hours,the pain score,maternal childbirth response scale （CCB） and anxiety by comprehensive hospital anxiety and depression table （HAD） were assessed.Results The spontaneous delivery rate and tolerable pain of the observation group were 90.0%（270/300） and 73.7% （221/300） respectively,which were higher than those of the control group [83.3%（250/300） and 62.0% （186/300）].The maternal perineum II degree laceration and neonatal asphyxia rates of the observation group were 8.3%（25/300） and 1.7% （5/300） respectively,which were lower than thsoe of the control group [12.3%（37/300） and 4.3% （13/300） respectively],the differences were statistically significant（χ2=9.31,9.84,9.05,8.39,all P〈0.05）.The maternal first labor time and postpartum hemorrhage of the observation group were （10.87±3.06）h and （121.60±15.11） mL,respectively,which were significantly lower than those of the control group [（11.69±2.48）h and （180.52±14.76）mL],the differences were statistically significant （t=8.92,9.74,all P〈0.05）.The HAD score of the observation group was （6.04±1.95）pionts,which was lower than （8.76±1.21）points of the control group.CCB score of the observation group was （49.82±7.61）points,which was higher than （45.33±6.90）points of the control group,the differences were statistically significant （t=10.15,11.32,all P〈0.05）.ConclusionTaking the free position with duole tools during maternal first labor stage can improve the natural delivery rate,tolerate pain and postpartum response ability significantly,the first labor stage significantly shortened,postpartum adverse reactions and psychological anxiety decreased.