助产士门诊对初产妇分娩及母婴结局的影响研究

Influence of midwife outpatient clinic on delivery analgesia effect and delivery outcomes of primiparae

目的探讨助产士产前指导门诊对初产妇分娩镇痛的效应及对分娩结局的影响。方法采用随机数字表法将2017年7月—2019年1月我院待产的130例初产妇随机分为对照组与干预组,各65例。对照组予常规分娩指导,分娩时用灵龟八法开穴电针镇痛;干预组在对照组基础上给予孕晚期28周后助产士门诊学习。比较两组产妇各产程时间、产后2 h出血量、会阴侧切率、阴道裂伤程度、盆底肌肉损伤及母婴并发症发生情况。结果干预组出现宫缩1 h、产程活跃期VAS评分低于对照组(P<0.05);干预组镇痛有效率高于对照组,但差异无统计学意义(P>0.05);干预组宫口开至6 cm及全开时强啡肽(NYN)高于对照组(P<0.05),促肾上腺皮质激素(ACTH)及皮质醇(Cor)低于对照组(P<0.05);干预组第一产程、第二产程、第三产程时间均短于对照组(P<0.05);两组会阴侧切率、会阴Ⅰ度裂伤、盆底肌损伤率及母婴各不良事件发生率比较差异无统计学意义(P>0.05)。结论助产士产前门诊对初产妇进行指导,有利于提高分娩镇痛效果,促进产程进展,减轻机体应激,有助于改善母婴结局。

Objective To study the effect of midwife outpatient clinic of antenatal guidance on delivery analgesia and its influence on delivery outcomes of primiparae.Methods A total of 130 primiparae who came to our hospital for delivery from July 2017 to January 2019 were randomly divided into control group and intervention group,with 65 cases in each group.Control group received routine delivery guidance,and underwent Linggui Bafa electroacupuncture analgesia during delivery,and intervention group received midwife outpatient clinic study after 28 weeks of the third trimester on the basis of control group.The times of stages of labor,blood loss volume at 2h after delivery,perineotomy rate,vaginal laceration degree and pelvic floor muscle injury were compared among each group.The incidence rates of maternal-infant complications were statistically analyzed.Results The VAS score after 1 h of contraction and at active stage of labor in intervention group was lower than that in control group(P<0.05).The effective rate of analgesia was higher in intervention group than in control group(P>0.05).The levels of dynorphin at 6 cm opening and full opening of uterus orifice were higher(P<0.05)while the levels of adrenocorticotropic hormone and cortisol were lower in intervention group than in control group(P<0.05).The times of first,second and third stages of labor in intervention group were shorter than control group(P<0.05).No statistical significance was found in comparison of perineotomy rate,I degree perineal laceration,pelvic floor muscle injury rate and incidence rates of adverse maternal-infant events between the two groups(P>0.05).Conclusion Midwife outpatient clinic of antenatal guidance can help enhance the delivery analgesia effect,promote the progress of labor,reduce the body stress,and help to improve the maternal-infant outcomes.