水中分娩与硬膜外麻醉无痛分娩对母婴结局的影响研究
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摘要
目的比较水中分娩与硬膜外麻醉无痛分娩的分娩结局,分析水中分娩的有效性和安全性。方法选取2015年1月至2016年12月进行水中分娩的产妇692例为试验组,选取同期行硬膜外麻醉无痛分娩的产妇732例为对照组,观察2组孕妇的产程时长、会阴损伤情况、产后出血量、新生儿评分等分娩结局指标。结果与对照组相比,试验组产妇的第一产程、第二产程、第三产程时间较短、会阴损伤较小、助产率较低,新生儿1 min评分高于对照组,差异有统计学意义(P<0.05);产后出血量、新生儿5 min、10 min评分的差异无统计学意义(P>0.05)。结论水中分娩较硬膜外麻醉无痛分娩有缩短产程、减轻会阴损伤等优势,并不增加新的分娩风险,为不能接受硬膜外麻醉的孕妇及其家庭提供了更多的分娩选择。
Objective To compare the effects between birth in water and epidural anesthesia painless delivery on maternal-infant outcome,and to explore the effectiveness and safety of birth in water. Methods A total of 692 parturients who underwent birth in water in our hospital from January 2015 to December 2016 were enrolled as experimental group,at the same time,the other 732 parturients who underwent epidural anesthesia painless delivery were enrolled as control group. The length of labor,perineal injury,postpartum hemorrhage volume,neonatal scores were observed and compared between two groups.Results The lengths of first stage of labor,second stage of labor and third stage of labor in experimental group were shorter than those in control group,and perineal injury was less and midwifery rate was lower,however,the scores of 1 minute were significantly higher than those in control group( P < 0. 05). In addition there were no significant differences in postpartum hemorrhage volume,neonatal 5-minute and 10-minute scores between two groups( P > 0. 05). Conclusion The birth in water is superior to epidural anesthesia painless delivery,which can shorten birth process,relieve perineal injury,without increasing risk of childbirth,which provide more options of delivery mode for the pregnant women who can not accept epidural anesthesia.
Objective To compare the effects between birth in water and epidural anesthesia painless delivery on maternal-infant outcome,and to explore the effectiveness and safety of birth in water. Methods A total of 692 parturients who underwent birth in water in our hospital from January 2015 to December 2016 were enrolled as experimental group,at the same time,the other 732 parturients who underwent epidural anesthesia painless delivery were enrolled as control group. The length of labor,perineal injury,postpartum hemorrhage volume,neonatal scores were observed and compared between two groups.Results The lengths of first stage of labor,second stage of labor and third stage of labor in experimental group were shorter than those in control group,and perineal injury was less and midwifery rate was lower,however,the scores of 1 minute were significantly higher than those in control group( P < 0. 05). In addition there were no significant differences in postpartum hemorrhage volume,neonatal 5-minute and 10-minute scores between two groups( P > 0. 05). Conclusion The birth in water is superior to epidural anesthesia painless delivery,which can shorten birth process,relieve perineal injury,without increasing risk of childbirth,which provide more options of delivery mode for the pregnant women who can not accept epidural anesthesia.
引文
1 Hawkins JL.Epidural analgesia for labor and delivery.New England Journal of Medicine,2010,362:1503-1510.
2 范玲,吴连方.产妇分娩期的生理及心理特点.中国实用妇科与产科杂志,2005,21:276-278.
3 施向阳.分娩疼痛程度及其相关影响因素与分娩结局.中国现代医生,2013,51:127-129.
4 Levett KM,Smith CA,Dahlen HG,et al.Acupuncture and acupressure for pain management in labour and birth:a critical narrative review of current systematic review evidence.Complementary Therapies in Medicine,2014,22:523-540.
5 El-Wahab N,Robinson N.Analgesia and anaesthesia in labour.Obstetrics,Gynaecology&Reproductive Medicine,2014,24:97-102.
6 严相默.产科镇痛与生理学基础.实用妇科与产科杂志,1992,8:296.
7 Reynolds F,Sharma SK,Seed PT.Analgesia in labour and fetal acid-base balance:a meta-analysis comparing epidural with systemic opioid analgesia.British Journal of Obstetrics&Gynaecology,2002,109:1344-1353.
8 Pagano E,De RB,Ferrando A,et al.An economic evaluation of water birth:the cost-effectiveness of mother well-being.Journal of Evaluation in Clinical Practice,2010,16:916-919.
9 Bodner-Adler B,Bodner K,Kimberger O,et al.The effect of epidural analgesia on the occurrence of obstetric lacerations and on the neonatal outcome during spontaneous vaginal delivery.Archives of Gynecology&Obstetrics,2003,267:130-133.
10 刘春艳.椎管内麻醉镇痛对产程及母婴结局的影响.中国现代药物应用,2015,9:173-174.
11 Odent M.Birth under water.Lancet,1983,2:1476-1477.
12 Henderson J,Burns EE,Regalia AL,et al.Labouring women who used a birthing pool in obsteric units in Italy:prospective observational study.Bmc Pregnancy&Childbirth,2014,14:17.
13 杨小风,王凯,王雅莉.水中分娩对母儿安全性的研究.中国妇幼保健,2014,29:1288-1290.
14 伍东红,张贤,李晓燕,等.水中分娩与传统分娩方式对产妇和新生儿影响的分析.中国妇幼保健,2013,28:4454-4456.
15 Wu CJ,Chung UL.The decision-making experience of mothers selecting waterbirth.Journal of Nursing Research,2003,11:261-268.
16 林杏娟.会阴侧切术对初产妇盆底功能的影响.中国医药指南,2012,101:221-222.
17 杨俊红,冯晓明,于树静,等.无保护会阴阴道分娩应用椎管内麻醉镇痛对母婴结局的影响.河北医药,2013,35:2768-2769.
18 彭军,缪士霞,李志彬.水中分娩324例优势探讨.实用医学杂志,2013:2283-2285.
19 李爱乔,宋伟夫,周福霞.水中分娩与硬膜外麻醉无痛分娩的临床效果分析.中国妇产科临床杂志,2014,15:74-75.
20 Carpenter L,Weston P.Neonatal respiratory consequences from water birth.Journal of Paediatrics&Child Health,2012,48:419-423.
21 缪士霞,吴哲,王英深,等.水中分娩缸水细菌污染与母婴感染相关性探讨.中国实用妇科与产科杂志,2008,24:931-933.
22 肖兵,陈晓琴,蒋庆源,等.703例水中分娩对新生儿窒息的影响分析.实用妇产科杂志,2013,29:609-612.
23 李爱乔,马晓莉,宋伟夫.水中分娩新生儿脐动脉血血气分析及临床意义.西部医学,2014,26:613-615.
2 范玲,吴连方.产妇分娩期的生理及心理特点.中国实用妇科与产科杂志,2005,21:276-278.
3 施向阳.分娩疼痛程度及其相关影响因素与分娩结局.中国现代医生,2013,51:127-129.
4 Levett KM,Smith CA,Dahlen HG,et al.Acupuncture and acupressure for pain management in labour and birth:a critical narrative review of current systematic review evidence.Complementary Therapies in Medicine,2014,22:523-540.
5 El-Wahab N,Robinson N.Analgesia and anaesthesia in labour.Obstetrics,Gynaecology&Reproductive Medicine,2014,24:97-102.
6 严相默.产科镇痛与生理学基础.实用妇科与产科杂志,1992,8:296.
7 Reynolds F,Sharma SK,Seed PT.Analgesia in labour and fetal acid-base balance:a meta-analysis comparing epidural with systemic opioid analgesia.British Journal of Obstetrics&Gynaecology,2002,109:1344-1353.
8 Pagano E,De RB,Ferrando A,et al.An economic evaluation of water birth:the cost-effectiveness of mother well-being.Journal of Evaluation in Clinical Practice,2010,16:916-919.
9 Bodner-Adler B,Bodner K,Kimberger O,et al.The effect of epidural analgesia on the occurrence of obstetric lacerations and on the neonatal outcome during spontaneous vaginal delivery.Archives of Gynecology&Obstetrics,2003,267:130-133.
10 刘春艳.椎管内麻醉镇痛对产程及母婴结局的影响.中国现代药物应用,2015,9:173-174.
11 Odent M.Birth under water.Lancet,1983,2:1476-1477.
12 Henderson J,Burns EE,Regalia AL,et al.Labouring women who used a birthing pool in obsteric units in Italy:prospective observational study.Bmc Pregnancy&Childbirth,2014,14:17.
13 杨小风,王凯,王雅莉.水中分娩对母儿安全性的研究.中国妇幼保健,2014,29:1288-1290.
14 伍东红,张贤,李晓燕,等.水中分娩与传统分娩方式对产妇和新生儿影响的分析.中国妇幼保健,2013,28:4454-4456.
15 Wu CJ,Chung UL.The decision-making experience of mothers selecting waterbirth.Journal of Nursing Research,2003,11:261-268.
16 林杏娟.会阴侧切术对初产妇盆底功能的影响.中国医药指南,2012,101:221-222.
17 杨俊红,冯晓明,于树静,等.无保护会阴阴道分娩应用椎管内麻醉镇痛对母婴结局的影响.河北医药,2013,35:2768-2769.
18 彭军,缪士霞,李志彬.水中分娩324例优势探讨.实用医学杂志,2013:2283-2285.
19 李爱乔,宋伟夫,周福霞.水中分娩与硬膜外麻醉无痛分娩的临床效果分析.中国妇产科临床杂志,2014,15:74-75.
20 Carpenter L,Weston P.Neonatal respiratory consequences from water birth.Journal of Paediatrics&Child Health,2012,48:419-423.
21 缪士霞,吴哲,王英深,等.水中分娩缸水细菌污染与母婴感染相关性探讨.中国实用妇科与产科杂志,2008,24:931-933.
22 肖兵,陈晓琴,蒋庆源,等.703例水中分娩对新生儿窒息的影响分析.实用妇产科杂志,2013,29:609-612.
23 李爱乔,马晓莉,宋伟夫.水中分娩新生儿脐动脉血血气分析及临床意义.西部医学,2014,26:613-615.