自由体位分娩对初产妇分娩结局的影响研究

The effect of free posture delivery on the outcome of primipara

目的研究自由体位分娩对初产妇分娩结局影响。方法选取2015年5月至2017年6月西安市第四医院产科接收的初产妇2 860例,按照随机数字表法平均分为两组,剔除分娩过程中使用催产药物和试产失败产妇,自由体位分娩组1 420例,常规体位分娩组1 419例。观察两组产妇分娩过程中各产程时间、阴道出血量、产时疼痛、分娩控制感、会阴裂伤及侧切情况,统计两组产钳助产率、中转剖宫产率以及新生儿Apgar评分。结果自由体位分娩组第一产程时间、第二产程时间及总产程时间均明显短于常规体位分娩组,差异有统计学意义(P<0.05)。自由体位分娩组产妇视觉模拟量表(visual analogue scale,VAS)、语言反应量表(verbal rating scale,VRS)、现实疼痛强度量表(present pain intensity,PPI)评分低于常规体位分娩组,分娩控制量表(labour agentry scale,LAS)评分高于常规体位分娩组,产后出血、会阴裂伤、产钳助产、会阴侧切、中转剖宫产的发生率低于常规分娩体位组,自由体位分娩组新生儿Apgar评分为0~3分的少于常规体位分娩组,而8~10分多于常规体位分娩组,差异均有统计学意义(P<0.05)。结论自由体位对于初产妇效果理想,有助于改善分娩结局,降低应激反应,缩短产程时间,值得临床推广应用。

Objective To study the effect of free posture delivery on the outcome of primipara. Methods From May 2015 to June 2017,2 860 primipara hospitalized in the Obstetric Department of the Fourth Hospital of Xi＇an were randomly divided into two groups according to the random number table method. The primipara using of oxytocin and failed maternal were eliminated,1 420 cases were set as free posture delivery group and 1 419 as conventional posture delivery group. The labor time,vaginal bleeding,pain,birth control,perineal laceration and lateral incision,forceps delivery rate,transit cesarean section rate and neonatal＂Apgar＂score of two groups were compared. Results Free position delivery time of the the first and second stage of labor time,the total labor time of free posture delivery group was significantly shorter than the conventional position delivery group, the differences were statistically significant（ P〈0. 05）. The VAS,VRS,and PPI scores of the free postpartum delivery group were significantly lower than those of the conventional postpartum delivery group. The LAS score was significantly higher than that of the conventional postpartum delivery group.Postpartum hemorrhage,the rate of perineal laceration,forceps delivery,episiotomy,and transit cesarean delivery were significantly lower than those of the conventional postpartum delivery group,the differences were statistically significant（ P〈0. 05）. Conclusion The free position is ideal for the primipara,which can help improve the outcome of delivery,reduce the stress response,and shorten the birth process. It is worth popularizing and applying.