导乐陪伴联合分娩镇痛对促进初产妇自然分娩的影响分析

Analysis of the effect of Doula accompany combined with labor analgesia on the natural delivery of primipara

目的分析导乐陪伴联合分娩镇痛对初产妇产程及分娩结局的影响。方法回顾性选取首都医科大学附属北京友谊医院2019年1月1日至2019年9月30日收治的200例初产妇作为研究对象。所有患者均实施分娩镇痛,依据是否实施导乐分娩分成导乐组100例和对照组100例(无导乐分娩),采用两独立样本的t检验和x^(2)检验,比较两组产妇的产程及分娩结局。结果导乐组自然分娩率为76%(76/100),明显高于对照组[61%(61/100)],两组比较差异有统计学意义(x^(2)=5.214,P=0.022)。导乐组第一、二、三产程时间分别为(8.35±3.59)、(1.07±0.26)、(0.54±0.19)h,对照组分别为(10.94±4.76)、(1.86±0.63)、(0.78±0.21)h,两组比较差异均有统计学意义(t=10.354,P=0.016;t=5.312,P=0.042;t=8.169,P=0.039)。导乐组及对照组新生儿窒息率分别为1%(1/100)、3%(3/100),两组比较差异无统计学意义(P=0.621)。导乐组及对照组产后出血发生率分别为3%(3/100)、10%(10/100),产后尿潴留发生率分别为0(0/100)、6%(6/100),新生儿早吸吮成功率分别为98%(98/100)及90%(90/100),两组比较差异均有统计学意义(P值分别0.045、0.029、0.017)。导乐组的住院时间为(3.17±0.85)d,明显短于对照组(5.64±1.29)d,两组比较差异有统计学意义(t=6.359,P=0.031)。导乐组患者产后2 h视觉模拟疼痛评分为(3.49±0.98)分,明显低于对照组(5.82±1.06)分,两组比较差异有统计学意义(t=9.327,P<0.001)。结论导乐分娩联合分娩镇痛能有效减轻宫缩疼痛,促进自然分娩,降低剖宫产率,有助于提高产科医疗服务质量,提升患者满意度,值得在有条件的医院进行推广。

Objective To analyze the effect of Doula delivery combined with labor analgesia on the delivery process and delivery outcomes of primiparas.Methods Retrospectively selected 200 primiparas treated in Beijing Friendship Hospital,Capital Medical University from January 1,2019 to September 30,2019 as the research objects.All patients underwent labor analgesia,and were divided into 100 cases in the Doula group and 100 cases in the control group(without Doula delivery)according to whether or not Doula delivery was performed.T test of two independent samples and chi square test were used to compare the labor process and delivery outcome of the two groups.Results The natural delivery rate in the Doula group was 76%(76/100),which was significantly higher than the control group(61%(61/100)),and the difference was statistically significant(x^(2)=5.214,P=0.022).The time of the first,second and third stage of labor in Doula group was(8.35±3.59),(1.07±0.26),(0.54±0.19)h,and that in the control group was(10.94±4.76),(1.86±0.63),(0.78±0.21)h,respectively.There were significant differences between the two groups(t value were 10.354,5.312 and 8.169,respectively;P value were 0.016,0.042 and 0.039,respectively).The neonatal asphyxia rates of Doula group and control group were 1%(1/100)and 3%(3/100)respectively,and there was no significant difference between the two groups(P=0.621).The incidence of postpartum hemorrhage in the Doula group and the control group was 3%(3/100)and 10%(10/100)respectively,and the incidence of postpartum urinary retention was 0(0/100)and 6%(6/100),respectively.The success rate of early sucking was 98%(98/100)and 90%(90/100)respectively,and the difference between the two groups was statistically significant(P value were 0.045,0.029 and 0.017,respectively).The hospitalization time of Doula group was(3.17±0.85)d,which was significantly shorter than that of the control group(5.64±1.29)d)(t=6.359,P=0.031).The visual analogue pain score of 2 h postpartum in Doula group was 3.49±0.98,which was significantly lower than the control group(5.82±1.06)(t=9.327,P<0.001).Conclusion Doula delivery combined with labor analgesia can effectively reduce the pain of uterine contraction,promote natural delivery,reduce the rate of cesarean section,help to improve the quality of obstetric medical service,improve patient satisfaction,it is worth promoting in the condition of the hospital.