耳穴贴压干预自由体位联合无保护会阴分娩技术在初产妇第二产程中的对比研究

Effects of the combined therapy of the auricular-point pressure at the free position and the unprotected perineal delivery technique during the second stage of labor in the primiparas

目的:探讨耳穴贴压干预自由体位联合无保护会阴分娩技术在第二产程中对初产妇分娩效果的影响,从而提高临床产时生产质量。方法:选取愿意接受自然分娩的初产妇146例,按就诊先后顺序随机分为观察组(72例)和对照组(74例)。两组均采用自由体位联合无保护会阴分娩法进行生产,且在此基础上,观察组在进入活跃期开始实施王不留行籽耳穴贴压,取穴盆腔、子宫、内生殖器、皮质下、神门、交感、脾及胃,每次按压1～2 min,每10～20分钟重复1次,直至第二产程结束。记录并比较两组初产妇的会阴侧切率、会阴裂伤程度、会阴疼痛程度、第二产程时间、产后出血、产后尿潴留及新生儿窒息率。结果:两组均未出现Ⅲ度或Ⅳ度裂伤。与对照组比较,观察组会阴裂伤程度治疗效果较优(P<0.05),且会阴侧切率5.6%(4/72)较低(P<0.05),但总会阴裂伤率68.1%(49/72)较相近(P>0.05)。观察组新生儿窒息率为1.4%(1/72)、产后出血率为6.9%(5/72)及尿潴留发生率为5.6%(4/72),分别低于对照组的10.8%(8/74)、18.9%(14/74)和17.6%(13/74,均P<0.05)。观察组产后第1、2、3天会阴疼痛程度及第二产程时间均优于对照组(均P<0.001)。结论:耳穴贴压干预自由体位联合无保护会阴分娩技术在第二产程中有效降低初产妇会阴侧切率,减轻会阴裂伤程度及缓解会阴疼痛和降低新生儿窒息率,提高了产时生产质量。

Objective To observe the effects of the combined therapy of the auricular-point pressure at the free position and the unprotected perineal delivery technique during the 2 nd stage of labor in the primiparas so as to improve the clinical delivery quality. Methods A total of 146 primiparas who accepted the natural delivery willingly were collected. According to the visit sequence, they were divided into an observation group（72 cases） and a control group（74 cases）. The free position and the unprotected perineal delivery were adopted in combination during the labor in both of the two groups. Additionally, in the observation group, the auricular-point pressure with semen vaccariae was intervened when entering the active phase. The points were pengqiang（TF5）, zigong（uterus）, neishengzhiqi（TF2）, pizhixia（AT4）, shenmen（TF4）, jiaogan（AH6 a）, pi（CO13） and wei（CO4）. Each point was pressed for 1 to 2 min each time, repeated once every 10 to 20 min until the end of the 2 nd stage of labor. The episiotomy rate, perineal laceration degree, perineal pain degree, the duration of the 2 nd labor stage, postpartum hemorrhage, postpartum urine retention and neonatal asphyxia rate were recorded and compared in the primiparas between the two groups. Results The perineal laceration of the degree Ⅲ and Ⅳ did not occur in the two groups. Compared with the control group, the effect on the perineal laceration was better in the observation group（P0.05）. The episiotomy rate was 5.6%（4/72） in the observation group, lower than that in the control group（P0.05）. The total perineal laceration rate was 68.1%（48/72） in the observation group, similar to the control group（P0.05）. In the observation group, the neonatal asphyxia rate was 1.4%（1/72）, the postpartum hemorrhage 6.9%（5/72） and the incidence of urine retention 5.6%（4/72）, all lower than 10.8%（8/74）, 18.9%（14/74） and 17.6%（13/74） in the control group respectively（all P0.05）. In the observation group, on the 1 st, 2 nd and 3 rd days after labor, the perineal pain degree and the duration of the 2 nd stage of labor were superior to the control group（all P0.001）. Conclusion The combined therapy of the auricular-point pressure intervention at the free position and the unprotected perineal delivery technique effectively reduces the episiotomy rate and perineal laceration degree, relieves the perineal pain, reduces the neonatal asphyxia rate and improves the delivery quality during the 2 nd stage of labor in the primiparas.