助产服务路径对连续硬膜外麻醉镇痛分娩结局及泌乳始动的影响

Application of midwifery service pathway on the childbirth outcome and lactation initiate with continuous epidural analgesia in labor

目的探讨实施助产服务路径后对硬膜外分娩镇痛产妇的分娩结局改善情况及泌乳始动的影响。方法方便抽样选择2016年7月-2018年4月间在我院产房行连续硬膜外分娩镇痛产妇111例作为观察组;2014年7月-2016年6月间分娩镇痛产妇108例作为历史对照组。两组产妇均于出现规律宫缩伴子宫颈口扩张约2~3 cm时行硬膜外镇痛,对照组助产士按常规流程进行产程观察护理。观察组助产士执行助产服务路径,以时间顺序为横轴,观察护理措施为纵轴,制定计划表。比较两组的分娩结局及泌乳始动时间的差异。结果观察组产程平均时间、产时与产后24 h出血量、产后6 h内排尿困难及尿潴留发生率与对照组比较差异无统计学意义(P>0.05);观察组产妇会阴侧切率(53.15%)低于对照组(66.67%),差异有统计学意义(P<0.05);观察组平均泌乳始动时间(4.81±4.26)h短于对照组(9.06±6.23)h,总体满意度水平高于对照组,差异有统计学意义(P<0.01)。结论实施助产服务路径,加强并规范了助产士的服务意识与行为,提高了助产服务质量,是分娩镇痛产程管理的有效途径与模式。

Objective To study the improvement of delivery outcome and the effect of lactation initiate that puerperas with continuous epidural analgesia in labor after practice the midwifery service pathway. Method 111 puerperas with continuous epidural analgesia in labor in the department of obstetrics from July 2014 to June 2016 was selected by Non-random convenient sampling method was adopted as study group. 108 parturients with labor analgesia from July 2014 to June 2016 served as historical control group. Both groups had epidural analgesia when the cervical expanded 2 to 3 cm.Control group was treated by routine nursing. The study group was performed the midwifery service pathway, then make a nursing schedule. The differences of delivery outcome and lactation initiation time between the two groups were compared. Results There were no significant differences in the average time of labor, the amount of bleeding during delivery and 24 hours after delivery, the incidence of dysuria and urinary retention within 6 hours after delivery between the two groups(P>0.05). The rate of lateral perineal excision(53.15%) in the study group was lower than that in the control group(66.67%). There was statistically significant difference(P<0.05). The perineal incision rate(53.15%) in the study group was lower than that in the control group(66.67%). There was statistical significant difference(P<0.05). The average lactation initiation time(4.81±4.26) h) in the study group was shorter than that in the control group(9.06±6.23) h). The overall satisfaction level in study group was higher than that in the control group(P<0.01).Conclusion The implementation of the midwifery service pathway can strengthen and standardize the service consciousness and behavior of midwife, improve the quality of midwifery. It is the effective way and mode of labor analgesia management.