助产士参与疼痛管理结合水疗镇痛对分娩结局及产妇疼痛程度的影响

Effect of midwives′participation in pain management combined with hydrotherapy analgesia on delivery outcome and pain degree of parturient

目的探讨助产士参与疼痛管理结合水疗镇痛对分娩结局及产妇疼痛程度的影响。方法选择宁波大学医学院附属医院2018年9月一2019年9月分娩的足月产妇90例为研究对象,按照随机数字表法将其随机分为观察组和对照组,每组45例,对照组在常规产前干预的基础上进行水疗镇痛,观察组在对照组的基础上采取助产士参与的疼痛管理模式,比较两组产妇第一产程时间、第二产程时间、第三产程时间、产后2h出血量、分娩控制感量表(LAS)、会阴侧切率及转剖宫产率,比较两组产妇结束水疗时(T_(O))、宫口全开时(T_(1))、分娩时(T_(2))疼痛视觉模拟评分(VAS)及焦虑视觉模拟评分(VAS-A),比较两组新生儿脐动脉血糖(BG)、氢离子浓度指数(pH)、血氧分压(PO_(2))、碳酸氢根(HCO_(3))水平及1min阿氏(Apgar)评分,另比较两组不良分娩结局发生情况。结果观察组第一产程时间、第二产程时间及产后2h出血量显著低于对照组,LAS评分显著高于对照组,差异有统计学意义(P<0.05)。两组VAS、VAS-A评分组内比较T_(O)<T_(1)<T_(2),差异有统计学意义(t=0.648、2.277、2.700;2.671、3.757、2.298,P<0.05);观察组VAS评分T_(1)、T_(2)时显著低于对照组,VAS-A评分T_(O)、T_(1)、T_(2)时显著低于对照组,差异有统计学意义(t=0.268、0.914、0.893、0.608、1.087,P<0.05)。比较两组新生儿BG、pH、PO_(2)、HCO,及1minApgar评分,差异无统计学意义(P>0.05)。观察组不良分娩结局总发生率为17.78%,与对照组28.89%比较,差异无统计学意义(P>0.05)。结论助产士参与疼痛管理结合水疗镇痛能明显减轻产妇分娩时疼痛感和焦虑感,且不会增加不良分娩结局风险,临床价值较高。

Objective To study the effect of midwives’participation in pain management combined with hydrotherapy analgesia on the outcome of delivery and the degree of maternal pain.Methods A total of ninety full-term pregnant women from September 2018 to September 2019 were selected as the study objects,and they were randomly divided into experimental group and control group according to the random number table method,forty-five cases in each group,The control group received hydrotherapy and analgesia on the basis of routine prenatal intervention,and the experimental group adopted the pain management mode in which the midwife participated on the basis of the control group,The first stage of labor,the second stage of labor,the third stage of labor,the amount of 2 hours postpartum hemorrhage,the delivery control scale(LAS),the rate of lateral perineum incision and the rate of cesarean section were compared between the two groups,The visual analogue score of pain(VAS)and visual analogue score of anxiety(VAS-A)at the end of hydrotherapy(T_(0)),at the time of full uterine opening(T1),at the time of delivery(T_(2))were compared between the two groups,The levels of blood glucose(BG),hydrogen ion concentration index(pH),blood oxygen partial pressure(PO_(2)),bicarbonate(HCO_(3))and Apgar score in one minute were compared between the two groups.Results The first stage of labor,the second stage of labor and the amount of postpartum hemorrhage in the experimental group were significantly lower than those in the control group,and the LAS score was statistically significantly higher than that in the control group(P<0.05).The difference between the two groups was statistically significant(P<0.05).The VAS and VAS-A scores of the two groups were compared within the group T02,HCO3and 1 min Apgar scores of the two groups of newborns,the difference was not statistically significant(P>0.05).The total incidence of adverse labor outcomes in the experimental group was 17.78%,compared with 28.89%in the control group,the difference was not statistically significant(P>0.05).Conclusion The participation of midwives in pain management combined with hydrotherapy analgesia can significantly reduce the pain and anxiety of parturients during labor,and will not increase the risk of adverse labor outcomes,and has high clinical value.