产时综合评估指标在会阴保护中的应用与评价

Impact evaluation of comprehensive assessment system application during childbirth on the outcomes of perineum protection

目的评价产时综合评估指标对确定会阴保护方式及会阴结局的影响。方法采用质性研究与量性研究相结合的方法,选取阴道分娩的223例单胎、头位、初产妇作为应用对象,18名能够熟练掌握各种会阴保护方式的助产士作为产时综合评估指标使用者。对不同助产年限助产士的会阴保护方式,产妇会阴裂伤率、会阴侧切率进行比较,同时对10名助产士进行一对一半结构式深入访谈,了解产时综合评估指标的利弊。结果不同助产年限助产士的会阴侧切率比较,差异有统计学意义(P<0.05)。产妇会阴裂伤发生率及会阴切开率比较,差异无统计学意义(均P>0.05)。各组实际会阴保护方式与指征推荐会阴保护方式的符合率比较,差异无统计学意义(P>0.05)。通过访谈资料提炼出产时综合评估指标有一定临床指导意义,但仍存在一定缺陷两个主题。结论产时综合评估指标对临床会阴保护方式的选择有一定指导意义,但该体系在项目设置上存在一定缺陷,使用上仍存在一定局限性,需要结合现有研究证据及临床实际情况进行修改,以更好地满足助产士工作需求。

Objective To evaluate the impact of the comprehensive assessment system application on decision of perineum protection methods during childbirth and the outcomes of perineum.Methods A mixed method of qualitative and quantitative research was utilized,and 223 single birth primiparas with normal fetal position and underwent vaginal delivery were selected as study participants,and 18 midwives who grasped different perineum protection methods assessed the puerperas using a comprehensive assessment system.Then the perineum protection methods,rate of perineal laceration and episiotomy among puerperas delivered by midwives with different seniority were compared,and 10 midwives were interviewed deeply to understand strength and weakness of the comprehensive assessment system.Results There was significant difference in episiotomy rate among puerperas delivered by midwives with different seniority（P〈0.05）,while there were no significant differences in rate of perineal laceration and episiotomy among puerperas（P 〉0.05 for both）,and there was no significant difference between the real perineum protection methods and recommended method（P〉0.05）.And two themes were extracted based on interview data：the comprehensive assessment system during childbirth could guide clinical practice to some extent,while some limitations existed.Conclusion The comprehensive evaluation system during childbirth has some clinical guiding significance for choosing suitable perineum protection methods,but it has some shortcomings in item setting,which result in limitations in clinic application.It is necessary to modify the system according to existing research evidence and clinical practice to meet the needs of midwives better.