不同冰袋冷敷方案对分娩后会阴部疼痛的疗效比较

Comparison of the effects of different cold compress programs on perineal pain after delivery

目的探讨不同冰袋冷敷方案对分娩后会阴部疼痛的疗效差异,并分析自然分娩1h后使用镇痛药物的危险因素。方法选取2016年6月至2018年9月海口市妇幼保健院产科接收的137例自然分娩的孕妇作为研究对象。根据随机数字表法将所有孕妇分为对照组(n=42)、10min组(n=47)及20min组(n=48)。其中对照组孕妇分娩后常规护理,10min组在此基础上加用冰袋冷敷会阴部10min,20min组则冷敷20min。分别于术后即刻(T 1)、术后10min(T 2)、术后20min(T 3)以及术后1h(T 4)记录并对比三组孕妇会阴部皮肤温度以及当时视觉模拟疼痛评分(VAS),比较三组孕妇术后1h后使用止疼药物的人数以及术后1d对本次护理的满意程度评分。最后分析导致孕妇自然分娩后1h使用止疼药物的危险因素。结果T 4时20min组VAS评分与10min组、对照组相比较,差异具有统计学意义(P<0.05);T 3时对照组会阴部温度高于其他两组,而10min组会阴部温度高于20min组,差异具有统计学意义(P<0.05);20min组止痛效果不满意人数均少于其他两组,差异具有统计学意义(P<0.05);对照组使用止疼药物人数多于其他两组,而10min组使用药物人数多于20min组,差异具有统计学意义(P<0.05);未冷敷及会阴侧切是自然分娩结束1h后使用镇痛药的独立危险因素(OR=3.247,4.176,95%CI=1.746-6.375,0.954-8.473,P<0.05)。结论常规分娩后采取20min冰袋冷敷方案能有效缓解孕妇产后会阴部疼痛,并提升其护理满意度,而未使用冷敷及会阴侧切为孕妇自然分娩后1h使用止疼药物的独立危险因素。

Objective To investigate the curative effect of different cold compress programs on perineal pain after delivery,and to analyze the risk factors of using analgesic drugs at an hour after natural delivery.Methods 137 pregnant women that gave birth in the obstetrics department of Haikou City Maternal and Child Health Hospital from June 2016 to September 2018 were selected and divided into control group(n=42),10min group(n=47)and 20min group(n=48)according to the random number table method.Among them,the control group received routine care after delivery,while the 10min group received additionally ice packs to the perineum for 10 minutes and the 20min group for 20 minutes.Then,the temperature of the perineal skin and the visual analog pain score(VAS)of the three groups of pregnant women were recorded and compared at right after the delievery(T 1),10min postpartum(T 2),20min postpartum(T 3)and 1h postpartum(T 4).The number of patients who used painkillers 1h postpartum and the degree of satisfaction on the care a day postpartum were compared between among the three groups.The risk factors for the use of painkillers within 1h postpartum were analyzed.Results At T 4,the VAS score in the 20min group was significantly different from that in the 10min group and the control group,with statistically significant differences(P<0.05).The temperature of the perineal skin in the control group was the highest at T 3,followed by the 10 min group and the 20 min group,with statistically significant differences(P<0.05).The number of patients unsatisfied with the analgesic effect in the 20min group was smaller than the other two groups,with statistically significant differences(P<0.05).The number of patients taking painkillers in the control group was the largest,followed by the 10 min group and the 20 min group accordingly,with statistically significant differences(P<0.05).Not using cold compress and perineal lateral incision were independent risk factors for taking painkillers within an hour after natural delivery(OR=3.247,4.176,95%CI=1.746-6.375,0.954-8.473,P<0.05).Conclusions 20 minutes of cold compress after natural delivery can effectively relieve postpartum perineal pain and improve the satisfaction of nursing and not using cold compress and perineal lateral incision are the independent risk factors for taking painkillers within an hour after natural delivery.