导乐陪伴分娩两种镇痛干预效果评价

Effect evaluation of two labor analgesia methods with Doula services

目的评价导乐陪伴分娩过程中经皮神经电刺激(TENS)和水中分娩两种镇痛效果。方法选取2018年7月—2019年12月在杭州市妇产科医院分娩的初产妇150例,随机纳入TENS组、水中分娩组和对照组,分别实施TENS分娩镇痛、水中分娩镇痛和常规助产,均给予导乐陪伴。比较三组产妇视觉模拟评分(VAS)、产程时长和新生儿窒息情况。结果最终纳入TENS组45例,水中分娩组45例,对照组44例。三组产妇孕周、年龄、身高、体重、胎儿双顶径及新生儿出生体重比较,差异均无统计学意义(P>0.05)。产妇宫口开至2.5~3 cm、5~7 cm后0.5 h和10 cm时,TENS组和水中分娩组VAS评分均低于对照组(P<0.05),TENS组和水中分娩组VAS评分差异无统计学意义(P>0.05),镇痛方法与宫口直径对产妇VAS评分的影响无交互效应(P>0.05)。TENS组和水中分娩组第一产程时长均短于对照组(P<0.05),TENS组与水中分娩组第一产程时长差异无统计学意义(P>0.05)。TENS组、水中分娩组和对照组新生儿窒息率分别为2.22%、2.22%和4.55%,差异无统计学意义(P>0.05)。结论导乐陪伴分娩过程中,TENS和水中分娩均能有效缓解产妇分娩疼痛,缩短第一产程时间,两者镇痛效果差异不明显。

Objective To evaluate the effects of transcutaneous electrical nerve stimulation( TENS) and waterbirth withDoula services on the outcome of delivery.Methods From July 2018 to December 2019, 150 primiparas in HangzhouWomen’s Hospital were randomly divided into three groups: TENS, waterbirth and control groups. They were given TENS,waterbirth and conventional midwifery, accompanied by Doula services. The visual analogue scores( VAS), length of laborstages and neonatal asphyxia were compared.Results It finally included 45 cases in the TENS group, 45 cases in thewaterbirth group and 44 cases in the control group. There were no significant differences in gestational weeks, age,height, weight, fetal biparietal diameter and newborn birth weight among the three groups( P>0.05). The VAS scores ofTENS group and waterbirth group were lower than those of the control group( P<0.05), but there were nosignificant differences between the two groups( P>0.05) with the cervix open to 2.5-3 cm, 5-7 cm( 0.5 hours later) and10 cm. There was no interaction between the analgesia methods and cervix diameter( P>0.05). The duration of the firststage of labor in the TENS group and the waterbirth group was less than that in the control group( P<0.05), and therewas no significant difference between the TENS group and the waterbirth group( P>0.05). The asphyxia rate of neonatesin TENS group, waterbirth group and control group were 2.22%, 2.22% and 4.55%, respectively, with no significant difference( P>0.05).Conclusion Under Doula services, both TENS and waterbirth can effectively relieve the pain of deliveryand shorten the first stage of labor, without obvious differences.