认知行为干预对阴道分娩产妇产后出血及分娩结局的影响

Effect of cognitive behavioral intervention on postpartum bleeding and delivery outcomes in vaginal delivery puerperae

目的探讨认知行为干预对阴道分娩产妇产后出血及分娩结局的影响。方法选取2016年8月至2017年8月在安徽医科大学第一附属医院接受阴道分娩的82例产妇为研究对象,按照入院顺序,采用随机数字表法分为干预组和对照组,其中干预组43例,对照组39例。对照组采用常规护理,干预组在对照组基础上增加认知行为干预。分别在产妇入院时及干预后采用自制调查量表评价分娩知识、分娩态度及应对方式情况;孕妇分娩后测定其出血情况、并发症发生率及分娩结局。结果干预组分娩知识评分(19.02±0.33)分,分娩态度(43.02±1.74)分,应对方式(27.93±1.41)分,分别较对照组的分娩知识(15.12±1.24)分、分娩态度(36.72±3.45)分、应对方式(19.08±2.74)分高,差异有统计学意义(P<0.05);干预组产后2小时出血量(154.83±12.51)m L,产后24小时出血量(212.22±17.61)m L,均少于对照组[(387.42±36.76)m L、(463.55±29.84)m L],差异均有统计学意义(P<0.05);干预组并发症发生率4.65%较对照组23.08%低,差异有统计学意义(P=0.021);干预组新生儿不良结局发生率2.33%较对照组的15.38%低,差异有统计学意义(P=0.049)。结论认知行为干预可减少阴道分娩产妇产后出血量、产后并发症和新生儿不良结局发生率。

Objective To investigate the effects of cognitive behavioral intervention on postpartum hemorrhage and delivery outcomes in those puerperae with vaginal delivery. Methods 82 puerperae underwent vaginal delivery in our hospital between Aug 2016 and Aug2017 were collected as the study objectives,and then following their admission date,they were divided into the intervention group（ 43 cases）and the control group（ 39 cases） by means of random number table. Besides the routine nursing for the control group,women in the intervention group received additional cognitive behavioral intervention at the same time. Their childbirth knowledge,childbirth attitude and coping style in the two groups were evaluated by self-made survey scales at admission and after intervention. Meanwhile,their postpartum bleeding,incidence rate of complications,and delivery outcomes were recorded. Results The scores of childbirth knowledge,childbirth attitude and coping style in the intervention group were 19. 02 ± 0. 33,43. 02 ± 1. 74 and 27. 93 ± 1. 41,respectively,which were higher than those in the control group（ 15. 12 ± 1. 24,36. 72 ± 3. 45 and 19. 08 ± 2. 74）,with significant differences（ P〈0. 05）. The bleeding volume at 2 hours and 24 hours after parturition in the intervention group were both significantly lower than those in the control group [（ 154. 83 ± 12. 51）m L vs（ 387. 42 ± 36. 76） m L;（ 212. 22 ± 17. 61） m L vs（ 463. 55 ± 29. 84） m L; P〈0. 05]. The intervention group had a much lower incidence of postpartum complications（ 4. 65%） in comparison with the control group（ 23. 08%）,and their difference was significant（ P =0. 021）. Significant difference was also found between the two groups in the neonatal adverse outcomes（ 2. 33% vs 15. 38%; P = 0. 049）.Conclusion Through cognitive behavioral intervention,the postpartum hemorrhage,postpartum complications and neonatal adverse outcomes in those puerperae with vaginal delivery could be reduced.