分娩腹压训练装置应用于硬膜外镇痛初产妇第二产程的效果研究

Study on the effect of delivery abdominal pressure training device applied to the second stage of labor of epidural analgesia

目的探讨分娩腹压训练装置对行硬膜外镇痛初产妇第二产程及分娩结局的影响。方法将2018年3月至2019年3月在江苏省常州市第二人民医院行硬膜外自控镇痛的健康初产妇按住院顺序编号后以抛硬币法随机分为观察组126例和对照组122例。对照组产妇在进入第二产程后采用常规的口头指导用力,观察组产妇使用分娩腹压训练装置引导用力,观察学会用力所需的时间、第二产程及分娩结局。结果观察组产妇学会正确用力时间、第二产程时间、第二产程自我效能感评分、产后疲劳度评分分别为(13.56±5.32)min、(76.32±10.58)min、(121.38±17.52)分、(8.56±0.72)分,对照组分别为(25.47±7.65)min、(105.21±18.41)min、(101.42±14.32)分、(13.31±0.46)分,2组比较差异有统计学意义(t值为-10.326~11.002,均P<0.05);观察组产妇自娩率、胎吸助产率、产钳助产率、会阴侧切率、会阴正中切率、会阴撕裂>Ⅰ°率分别为94.44%(119/126)、4.76%(6/126)、0.79%(1/126)、9.52%(12/126)、11.11%(14/126)、6.35%(8/126),对照组分别为85.25%(104/122)、12.30%(15/122)、2.46%(3/122)、29.51%(36/122)、4.10%(5/122)、9.84%(12/122),2组比较差异有统计学意义(χ^(2)值为4.582~9.437,均P<0.05或0.01)。结论行硬膜外镇痛初产妇使用分娩腹压训练装置有助于缩短第二产程和学习用力时间,提高第二产程自我效能感,降低会阴损伤和疲劳程度,降低阴道助产率,有利于保障母儿安全。

Objective To explore the effect of the labor abdominal pressure training device on the second stage of labor and the outcome of labor in primiparas undergoing epidural analgesia.Methods The healthy primiparas who had patient controlled epidural analgesia were randomly divided into the observation group(126 cases)and the control group(122 cases).The control group used conventional oral instruction to force after entering the second stage of labor.The women in the observation group used the labor abdominal pressure training device to guide the force.The time required to learn to exert force,the second stage of labor and the outcome of labor were observed.Results The parturient women learned the correct time to exert force,the time of the second stage of labor,the self-efficacy score of the second stage of labor,and the post-natal fatigue score were(13.56±5.32)min,(76.32±10.58)min,(121.38±17.52)points,(8.56±0.72)points in the observation group,and(25.47±7.65)min,(105.21±18.41)min,(101.42±14.32)points,(13.31±0.46)points in the control group,the differences between the two groups were statistically significant(t values were-10.326-11.002,all P<0.05).The maternal spontaneous delivery rate,fetal assisted delivery rate,forceps assisted delivery rate,perineal lateral cut rate,perineal median cut rate,perineal tear>Ⅰ°rate were 94.44%(119/126),4.76%(6/126),0.79%(1/126),9.52%(12/126),11.11%(14/126),6.35%(8/126)in the observation group,and 85.25%(104/122),12.30%(15/122),2.46%(3/122),29.51%(36/122),4.10%(5/122),9.84%(12/122)in the control group,the differences between the two groups were statistically significant(χ^(2) values were 4.582-9.437,P<0.05 or 0.01).Conclusions The use of an abdominal pressure training device for labor in patient controlled epidural analgesia for pregnant women can shorten the second stage of labor and study the time of exertion,improve the self-efficacy of the second stage of labor,reduce the degree of perineal injury and fatigue,reduce the vaginal birth rate,and help protect Mother and child are safe.