徒手旋转胎头处理技术在枕横位和枕后位头位难产中的应用
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摘要
目的探讨徒手旋转胎头处理技术对于枕横位和枕后位难产产妇的最终分娩方式、母亲并发症情况以及婴儿并发症情况的影响。方法选取浙江省台州医院恩泽妇产医院院区妇产科2016年5月—2017年12月收治的80例枕横位和枕后位的产妇,以入院病例号为编号,按照随机数字表法,将80例枕横位或枕后位难产的产妇随机分成2组,对照组37例,观察组43例。对照组给予常规自然分娩方法,不做特殊干预,维持宫缩,出现产力减弱时给予催产素维持产力,按照顺产自然旋转分娩;观察组实施徒手旋转胎头处理方法。比较2组产妇最终分娩方式、母亲并发症情况以及婴儿并发症情况。结果观察组产妇阴道分娩35例(81.39%),明显高于对照组产妇的19例(51.35%),差异有统计学意义(P<0.05);观察组剖宫产例数8例(18.60%)明显低于对照组18例(48.65%),差异有统计学意义(P<0.05)。观察组产妇产伤、产后出血等并发症发生率小于对照组产妇(P<0.05);观察组新生儿并发症(呼吸窘迫、胎盘早剥、新生儿窒息和新生儿头皮损伤)总发生率为23.26%,小于对照组的45.95%(P<0.05)。结论徒手旋转胎头处理技术能够提高枕横位和枕后位难产产妇的自然分娩率,降低母婴并发症发生率,值得临床推广。
Objective To explore the effect of the technique of the free hand rotating fetal head on the final delivery mode,the maternal complications and the infant complications of dystocia in occipital transverse position and occipital posterior position.Methods Eighty patients with dystocia in occipital transverse position or occipital posterior position were randomly divided into two groups: the control group( 37 cases) and the observation group( 43 cases).The control group was given routine self-identification delivery method,no special intervention to maintain uterine contraction,and oxytocin to maintain labor force when the labor force weakened,according to the natural rotation of labor.The observation group was treated with free-hand rotating fetal head.The final delivery mode,maternal complications and infant complications were compared between the two groups.Results Observation group of patients with vaginal delivery in 35 cases( 81.39%),significantly higher than that in the control group of 19 patients( 51.35%),the difference was significant,P < 0.05; observation group cesarean section in 8 cases( 18.6%) was significantly lower than the control group of 18 cases( 48.65%),the difference was significant( P < 0.05).The incidence of complications such as birth injury and postpartum hemorrhage was lower in the observation group than that in the control group,P < 0.05; the total incidence of neonatal complications( distress,placental abruption,neonatal asphyxia,and neonatal scalp injury) in the observation group was 23.26%,less than 45.95% of the control group,P < 0.05.Conclusion The technique of hand-rotating fetal head treatment can increase the rate of spontaneous delivery in patients with dystocia in occipital and posterior position,and reduce the incidence of complications of mother and child,which is worth popularizing in clinic.
Objective To explore the effect of the technique of the free hand rotating fetal head on the final delivery mode,the maternal complications and the infant complications of dystocia in occipital transverse position and occipital posterior position.Methods Eighty patients with dystocia in occipital transverse position or occipital posterior position were randomly divided into two groups: the control group( 37 cases) and the observation group( 43 cases).The control group was given routine self-identification delivery method,no special intervention to maintain uterine contraction,and oxytocin to maintain labor force when the labor force weakened,according to the natural rotation of labor.The observation group was treated with free-hand rotating fetal head.The final delivery mode,maternal complications and infant complications were compared between the two groups.Results Observation group of patients with vaginal delivery in 35 cases( 81.39%),significantly higher than that in the control group of 19 patients( 51.35%),the difference was significant,P < 0.05; observation group cesarean section in 8 cases( 18.6%) was significantly lower than the control group of 18 cases( 48.65%),the difference was significant( P < 0.05).The incidence of complications such as birth injury and postpartum hemorrhage was lower in the observation group than that in the control group,P < 0.05; the total incidence of neonatal complications( distress,placental abruption,neonatal asphyxia,and neonatal scalp injury) in the observation group was 23.26%,less than 45.95% of the control group,P < 0.05.Conclusion The technique of hand-rotating fetal head treatment can increase the rate of spontaneous delivery in patients with dystocia in occipital and posterior position,and reduce the incidence of complications of mother and child,which is worth popularizing in clinic.
引文
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[18]钱兰.头位难产产妇助产护理中徒手旋转的应用意义研究[J].中国继续医学教育,2016,8(27):193-194.
[19]娄晓云.体位改变配合徒手矫正胎方位在头位难产中的临床应用价值[J].世界最新医学信息文摘,2016,16(95):90,96.
[20]杨敬梅.徒手旋转胎头术在持续性枕横位和枕后位产程处理中的作用[J].中国现代药物应用,2014,8(13):55-56.
[21]葛俊丽,陈必良,刘玉,等.气囊加力助产处理头位难产的回顾性病例对照研究[J].山西医科大学学报,2015,46(6):590-592.
[22]韩冰.正确处理头位难产在产科中的临床意义[J].中外医学研究,2016,14(23):138-139.
[23]刘艳.徒手旋转胎头辅以对侧卧位处理头位难产的临床效果观察[J].中国卫生标准管理,2015,6(13):77-78.
[2]孙梅玲,赵丽娜.头位难产早期识别和干预对策分析[J].中外女性健康研究,2016,24(14):22,28.
[3]李聪颖.20例头位难产产妇的临床诊断及治疗分析[J].世界最新医学信息文摘,2016,16(55):202.
[4]江钧.徒手复位旋转胎头降低头位难产的临床应用研究[J].中国实用医药,2017,12(35):9-11.
[5]周焕娣,杨林,李苗,等.间苯三酚配合自由体位处理产程中宫颈水肿患者临床疗效观察[J].中国现代药物应用,2017,11(11):27-29.
[6]邱万琼.头位难产的临床特点分析[J].世界最新医学信息文摘,2016,16(29):80-81.
[7]廖亚梅.浅析影响初产妇头位难产的因素、临床表现及其临床处理对策[J].世界最新医学信息文摘,2016,16(53):67,76.
[8]宋建平,姚泽宇,谢玉海,等.单管法与双管法硬膜外分娩镇痛对胎儿头位异常初产妇分娩结局的前瞻性随机对照研究[J].中国妇幼保健,2016,31(8):1630-1631.
[9]徐赛英.综合护理干预对枕横位及枕后位产妇产程和分娩结局的影响[J].中国计划生育学杂志,2016,24(3):183-186.
[10]刘慧.引起头位难产的因素分析及临床护理措施研究[J].中国保健营养,2016,26(4):279-280.
[11]邢建英,丁梦漪.头位难产徒手旋转胎头术的临床效果[J].中国实用医刊,2013,40(8):93-94..
[12]连玉巍.80例头位难产病例的诊断及处理[J].中国现代药物应用,2016,10(1):283-284.
[13]李慧龄.镇痛分娩下徒手旋转胎头纠正胎儿枕后位的效果观察[J].广西医学,2013,35(4):479-481.
[14]王丽红,刘美丽.分析引起头位难产的因素及临床护理手段[J].世界最新医学信息文摘,2016,16(48):246-247.
[15]黄金敬.头位难产产妇助产护理中徒手旋转的应用效果分析[J].中国医药指南,2015,13(33):242-243.
[16]吴安娜.探讨引起头位难产的因素及临床护理[J].中国药物经济学,2014,9(2):158-159.
[17]马妍蓉,张肃川,王英,等.认知行为干预对孕妇产后抑郁和血清肾上腺素、去甲肾上腺素水平的影响[J].心理医生,2017,23(20):152-153.
[18]钱兰.头位难产产妇助产护理中徒手旋转的应用意义研究[J].中国继续医学教育,2016,8(27):193-194.
[19]娄晓云.体位改变配合徒手矫正胎方位在头位难产中的临床应用价值[J].世界最新医学信息文摘,2016,16(95):90,96.
[20]杨敬梅.徒手旋转胎头术在持续性枕横位和枕后位产程处理中的作用[J].中国现代药物应用,2014,8(13):55-56.
[21]葛俊丽,陈必良,刘玉,等.气囊加力助产处理头位难产的回顾性病例对照研究[J].山西医科大学学报,2015,46(6):590-592.
[22]韩冰.正确处理头位难产在产科中的临床意义[J].中外医学研究,2016,14(23):138-139.
[23]刘艳.徒手旋转胎头辅以对侧卧位处理头位难产的临床效果观察[J].中国卫生标准管理,2015,6(13):77-78.