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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

34

期数:

2017年7

页码:

615-618

栏目:

临床研究

出版日期:

2017-07-05

文章信息/Info

Title:

Advantages of unprotected perineum combined with painless labor in promoting spontaneous delivery of primiparas

作者:

徐贵红¹; 徐桂梅²; 王永淑¹; 买　茹¹

（1.新乡医学院第三附属医院妇产科，河南　新乡　453003；2.郑州大学第三附属医院术后重症科，河南　郑州　450052）

Author(s):

XU Gui-hong¹; XU Gui-mei²; WANG Yong-shu¹; MAI Ru¹

（1.Department of Gynaecology and Obstetrics，the Third Affiliated Hospital of Xinxiang Medical University，Xinxiang 453003，Henan Province，China；2.Intensive Care Unit，the Third Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，Henan）Province，China

关键词:

会阴无保护; 无痛分娩; 自然分娩; 优势分析

Keywords:

perineal unprotected; painless childbirth; natural childbirth; superiority analysis

分类号:

R714.3

DOI:

10.7683/xxyxyxb.2017.07.016

文献标志码:

A

摘要:

目的　观察和评估会阴无保护联合无痛分娩对初产妇分娩过程和结局的影响。方法　选取2016年4月至2016年10月新乡医学院第三附属医院收治的无产科及相关并发症的初产妇365例，将其按照接产方式不同分为会阴保护分娩组（105例）、会阴无保护分娩组（110例）和会阴无保护联合无痛分娩组（150例）。其中会阴保护分娩组、会阴无保护分娩组采用传统非药物镇痛分娩方式，会阴无保护联合无痛分娩组采用椎管内药物镇痛分娩方式。对比3组初产妇的第2产程时间、新生儿Apgar评分、产后出血、住院时间、会阴裂伤程度、镇痛效果、新生儿窒息和产后并发症（伤口延期愈合、产褥期感染及产后尿潴留）发生情况。结果　会阴无保护联合无痛分娩组初产妇会阴完整率为57.33%（86/150），显著高于会阴保护分娩组的20.95%（22/105）和会阴无保护分娩组的37.27%（41/110）（χ²=46.038、18.186，P<0.05），会阴无保护分娩组初产妇会阴完整率显著高于会阴保护分娩组（χ²=6.907，P<0.05）；会阴无保护联合无痛分娩组初产妇会阴Ⅰ度、Ⅱ度裂伤率较会阴保护分娩组（χ²=10.309、23.328，P<0.05）和会阴无保护分娩组低（χ²=5.412、9.078，P<0.05），会阴无保护分娩组初产妇会阴Ⅰ度裂伤率与会阴保护分娩组比较差异无统计学意义（χ²=0.731，P>0.05），会阴Ⅱ度裂伤率低于会阴保护分娩组（χ²=3.086，P<0.05）。会阴无保护联合无痛分娩组镇痛优良率为83.33%（125/150），显著高于会阴保护分娩组的38.10%（40/105）和会阴无保护分娩组的42.73%（47/110）（χ²=131.463，P<0.05），会阴保护分娩组和会阴无保护分娩组初产妇镇痛效果优良率比较差异无统计学意义（χ²=0.281，P>0.05）；会阴无保护联合无痛分娩组初产妇的产后出血量、住院时间、新生儿窒息发生率、产后并发症发生率均低于会阴保护分娩组和会阴无保护分娩组（P<0.05），会阴无保护分娩组初产妇的产后出血量、住院时间与会阴保护分娩组比较差异无统计学意义（P>0.05），新生儿窒息发生率、产后并发症发生率均低于会阴保护分娩组（P<0.05），3组初产妇的第2产程时间、新生儿Apgar 评分比较差异均无统计学意义（P>0.05）。结论　会阴无保护联合无痛分娩是一种安全有效的分娩方式，能够明显减轻产妇的疼痛感，降低会阴损伤率，缩短住院时间，对母婴无不良影响，且能更好地促进自然分娩。

Abstract:

Objective　To explore the effect of unprotected perineum combined with painless labor on the delivery process and delivery outcome in primipara.Methods　A total of 365 primipara without maternity and related complications were selected in the Third Affiliated Hospital of Xinxiang Medical University from April 2016 to October 2016.All primipara were divided into perineum protection delivery group （n=105），unprotective perineum delivery group （n=110） and unprotective perineum combined with painless labor group （n=150） according to the delivery way.The primipara in the perineum protection delivery group and unprotective perineum adopted the traditional non drug analgesia delivery mode；the primipara in the unprotective perineum combined with painless labor group adopted spinal canal medicine analgesia delivery mode.The time of the second stage of labor，neonatal Apgar score，postpartum hemorrhage，duration of hospitalization，degree of perineal laceration，the effect of analgesia，neonatal asphyxia，postpartum complications （delay wound healing，puerperal infection and postpartum urinary retention） were compared among the three groups.Results　The perineal integrity rate in unprotective perineum combined with painless labor group（57.33%，86/150） was significantly higher than that in the perineum protection delivery group（20.95%，22/105） and unprotective perineum delivery group（37.27%，41/110）（χ²=46.038，18.186；P<0.05）；the perineal integrity rate in the unprotective perineum delivery group was significantly higher than that in the perineum protection delivery group（χ²=6.907，P<0.05）.The rates of degreeⅠof the perineal laceration and degree Ⅱ of the perineal laceration in unprotective perineum combined with painless labor group were significantly lower than those in the perineum protection delivery group（χ²=10.309，23.328；P<0.05）and unprotective perineum delivery group（χ²=5.412，9.078；P<0.05）；there was no statistic difference in the rate of degree Ⅰof the perineal laceration between the perineum protection delivery group and unprotective perineum delivery group（χ²=0.731，P>0.05）；the rate of degree Ⅱ of the perineal laceration in the unprotective perineum delivery group was significantly lower than that in the perineum protection delivery group（χ²=3.086，P<0.05）.The excellent rate in unprotective perineum combined with painless labor group（83.33%，125/150） was significantly higher than that in the perineum protection delivery group（38.10%，40/105） and unprotective perineum delivery group （42.73%，47/110） （P<0.05）；there was no statistic difference in the excellent rate between the perineum protection delivery group and unprotective perineum delivery group（χ²=0.281，P>0.05）.The postpartum hemorrhage，duration of hospitalization，the incidence of neonatal asphyxia and postpartum complications in unprotective perineum combined with painless labor group were significantly lower than those in the perineum protection delivery group and unprotective perineum delivery group（P<0.05）；there was no statistic difference in the time of the second stage of labor and neonatal Apgar score among the three groups（P>0.05）.Conclusion　The unprotective perineum combined with painless labor is a safe and effective way of delivery，it can significantly reduce the pain perception of puerpera，decrease the rate of perineal injury，shorten hospitalization time，can better promote the natural birth，and has no adverse effect on maternal and infant.

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更新日期/Last Update: 2017-07-05