两步法联合无保护会阴助产技术对新生儿咽下综合征发生率的影响研究

Effects of two-step approach combined with unprotected perineum method on the incidence of swallowing syndrome in neonates

目的评估"两步法"联合无保护会阴助产对新生儿咽下综合征发生率的影响。方法随机将我院分娩室360例待产孕妇分为A、B、C 3组,每组120例。A组采用传统助产方式,助产士用手控制胎头娩出速度,待胎头娩出后再协助胎肩娩出,新生儿完全娩出后迅速徒手清理并常规加用洗耳球吸除口鼻中的黏液。B、C两组采用"两步法"联合无保护会阴助产,助产士不用手干涉分娩过程,即在胎头娩出后自然停顿,等待下次宫缩再娩出胎肩,B组清理呼吸道同A组,C组助产方式同B组,新生儿娩出后只做体表擦拭清洁或徒手挤压口鼻清理呼吸道。比较3组出生后24 h内咽下综合征发生率及呕吐次数。结果 3组咽下综合征发生率比较,差异有统计学意义(χ~2=10.366,P=0.006),两两比较,A组高于B组(χ~2=6.504,P=0.011)和C组(χ~2=7.533,P=0.006);B、C两组比较,差异无统计学意义(χ~2=0.042,P=0.837)。3组出生24 h内呕吐次数比较,差异有统计学意义(F=10.185,P=0.006),两两比较,A组与B组、A组与C组比较,差异均有统计学意义(P<0.05);B组与C组比较差异无统计学意义(P>0.05)。结论应用"两步法"联合无保护会阴助产方式,在等待胎肩自然娩出过程中新生儿可以自然地完成呼吸道清理,降低新生儿咽下综合征的发生率。

Objective To evaluate the effects of two-step approach combined with unprotected perineum method on the incidence of neonatal swallowing syndrome. Methods A total of 360 patients were randomly divided into three groups：A,B and C,with 120 cases in each group. Group A was provided traditional midwifery approach： midwifery staff manually controlled the delivery rate of fetal head with hands,assisted to deliver fetal shoulders after fetal head was delivered,and quickly used hands to clean up the completely delivered newborn and routinely sucked mucus from mouth and nose using aurilave. Group B and C were provided two-step approach combined with unprotected perineum method： midwifery staff did not interfere delivery with hands,paused after the fetal head was delivered,delivered the fetal shoulders until next contraction. Group B was cleaned up respiratory tract like group A,group C was only provided surface cleaning or squeezing nose and mouth using hands. The incidence of neonatal swallowing syndrome and the number of vomiting were recorded within 24 hours after birth among three groups,and the differences among three groups were compared. Results The incidence of neonatal swallowing syndrome in group A was higher than those in groups B（xZ=6.504,P=0.011）and C0（2=7.533,P=0.006）;there was no significant difference between group A and B in neonatal swallowing syndrome0（2=0.042,P=0.837）. There were significant differences in vomiting within 24 hours among three groups（F=10.185 ,P=0.006）. There were significant differences in vomiting within 24 hours between group A and group B,and between group A and group C（P〈0.05）; there was no significant difference between group B and group C（P〉0.05）. Conclusion Inplementing the two-step approach combined with unprotected perineum method,the newborns can accomplish cleaning up respiratory tract naturally during natural delivery of fetal shoulders.