新法接生——不保护会阴的临床研究

New Delivery Method——Clinical Research on Unprotected Perineum

目的探讨不保护会阴接生的方法和效果。方法将2014年8月—2015年4月云南省昭通市第一人民医院研究期间内收治的150例住院初产待产妇随机分为实验组80例和对照组70例,由教研组里相同职称的两人在统一标准下,在同一时间段各自值班的过程中,进行接生处置,实验组实施不保护会阴接生,分娩前进行充分评估,做好产前宣教,指导产妇如何正确配合用力;对照组采取常规的接生方法,适时保护会阴,观察两组临床效果。结果实验组会阴侧切17例,明显较对照组的32例少(χ~2=4.592,P<0.05);会阴完整8例,而对照组无会阴完整者(χ~2=8.016,P<0.05);会阴1度裂伤45例,明显多于对照组的例(χ~2=4.459,P<0.05)新生儿窒息1例,明显少于对照组的4例(χ~2=3.817,P<0.05)。实验组产妇产后出血量为(265.12±32.20)mL,明显较对照组要少(t=13.264,P<0.05);第二产程时间为(45.5±1.5)min,明显较对照组长(t=3.124,P<0.05)。结论不保护会阴接生的处理方法是安全的,可大大的提高了自然分娩的成功率,降低了剖宫产率,减轻了产妇产后伤口疼痛,伤口愈合不良,产后出血的发生,又减少了产痛,利于产后恢复,母乳喂养成功率高。

Objective To study the method and effect of unprotected perineum. Methods 150 cases of delivery women waiting for labor in our hospital from August 2014 to April 2015 were selected, including the experimental group with 80 cases and the control group with 70 cases, and the delivery treatment was conducted under the unified standards at the same time period during duty, by the two staff of the same professional title, and the unprotected perineum delivery was implemented in the experimental group, and the adequate evaluation was conducted before delivery, and the education before delivery was done well, to guide the delivery women in the accurate labor, while the control group used the routine delivery, and protect the perineum in time, and the clinical effect of the two groups was observed. Results The occurrence cases of perineum lateral incision in the experimental group was obviously lower than that in the control group,（17 cases vs 32 cases）（χ^2=4.592,P〈0.05）; and the occurrence case of perineum integrity in the experimental group and in the control group was respectively 8 cases and 0（χ^2=8.016,P〈0.05）; the occurrence case of perineum laceration of degree 1 was 45 cases, which were obviously more than that in the control group（χ^2=4.459,P〈0.05）, and the occurrence case of asphyxia neonatorum was obviously lower than that in the control group,（1 case vs 4 cases）（χ^2=3.817,P〈0.05）, and the postpartum bleeding amount in the experimental group was obviously lower than that in the control group, which was（265.12±32.20）mL in the experimental group,（t=13.264,P〈0.05）; and the second labor time was obviously longer than that in the control group, which was（45.5 ±1.5）min,（t =3.124,P〈0.05）. Conclusion The treatment method of unprotected perineum is safe, which can greatly improve the successful rate of natural delivery, reduce the cesarean section rate, relieve the wound pains of delivery women after delivery and reduce the delivery pains and occurrence of postpartum hemorrhage with adverse wound healing, and contribute to the postpartum recovery, with high breast feeding.