分娩镇痛初产妇第二产程运用腹压的时机分析
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摘要
目的探讨分娩镇痛初产妇第二产程运用腹压的最佳时机。方法将172例经阴道分娩初产妇按入院时间分为对照组和观察组各86例。对照组宫口全开后即使用腹压,观察组胎先露下降至3 cm时使用腹压。比较两组第二产程时间、使用腹压时间、会阴裂伤程度、侧切率、产后疲倦度及分娩结局。结果观察组腹压使用时间显著短于对照组(P<0.01);第二产程时间两组比较,差异无统计学意义(P>0.05);观察组会阴裂伤程度显著轻于对照组,侧切率、产后疲倦评分、产后出血、新生儿窒息率显著低于对照组(P<0.05,P<0.01)。结论对分娩镇痛初产妇当胎先露下降至3 cm时使用腹压,可有效缩短腹压使用时间,同时改善产妇分娩结局。
Objective To explore the best timing of pushing with abdominal muscles during the second stage of epidural anesthesia assisted labor in primiparas.Methods Totally, 172 pregnant women going through first-time vaginal delivery under epidural anesthesia were sequentially assigned into 2 groups.The control group(n=86) were asked to push with the abdominal muscles after the cervix was fully opened, while the intervention group(n=86) were asked to push with the abdominal muscles when the fetus pre-sentation descended 3 cm.The length of second stage of labor, the length of pushing with the abdominal muscles, the degree of perineal laceration, the rate of episiotomy, the level of postpartum fatigue, and birth outcomes between the 2 groups were compared.Results The length of pushing with the abdominal muscles in the intervention group was significantly shorter than that in the control group(P<0.01).There was no significant difference in the length of second stage of labor between the 2 groups(P>0.05).The degree of perineal laceration was milder, the rate of episiotomy,bleeding, and neonatal asphyxia, and the postpartum fatigue score, was lower, in the intervention group than in the control group(P<0.05,P<0.01).Conclusion Pushing with the abdominal muscles when the fetus presentation descends 3 cm can effectively shorten the length of pushing, and improve the outcome of maternal delivery.
Objective To explore the best timing of pushing with abdominal muscles during the second stage of epidural anesthesia assisted labor in primiparas.Methods Totally, 172 pregnant women going through first-time vaginal delivery under epidural anesthesia were sequentially assigned into 2 groups.The control group(n=86) were asked to push with the abdominal muscles after the cervix was fully opened, while the intervention group(n=86) were asked to push with the abdominal muscles when the fetus pre-sentation descended 3 cm.The length of second stage of labor, the length of pushing with the abdominal muscles, the degree of perineal laceration, the rate of episiotomy, the level of postpartum fatigue, and birth outcomes between the 2 groups were compared.Results The length of pushing with the abdominal muscles in the intervention group was significantly shorter than that in the control group(P<0.01).There was no significant difference in the length of second stage of labor between the 2 groups(P>0.05).The degree of perineal laceration was milder, the rate of episiotomy,bleeding, and neonatal asphyxia, and the postpartum fatigue score, was lower, in the intervention group than in the control group(P<0.05,P<0.01).Conclusion Pushing with the abdominal muscles when the fetus presentation descends 3 cm can effectively shorten the length of pushing, and improve the outcome of maternal delivery.
引文
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[2] 洪彩香,马钦玲,刘晨霞,等.人工气囊腹压带对足月初产妇阴道分娩后出血的影响[J].中国妇幼健康研究,2017,28(11):1451-1453.
[3] 史晓红,张浩,罗凤梅.第二产程指导用力和自主用力对初产妇分娩结局及疲倦度的影响[J].护理学杂志,2016,31(12):23-25.
[4] 刘金艳,王艳丽,石进,等.胎盘早剥36例高危因素及妊娠结局临床分析[J].中国现代医生,2015,53(32):48-50,54.
[5] 谢幸,苟文丽.妇产科学[M].5版.北京:人民卫生出版社,2014,11.
[6] 胡晓娜,林素青,余丽珍.活跃晚期和第二产程初期支撑式前倾坐位对产妇分娩结局的影响[J].护理学杂志,2016,31(18):49-51.
[7] Gupta M,Angeli F,Bosma H,et al.Utilization of intergovernmental funds to implement maternal and child health plans of a multi-strategy community intervention in Haryana,North India:a retrospective assessment[J].Pharmacoecon Open,2017,1(4):265-278.
[8] 杨春荣,张雅,王剑鹰,等.卡前列素氨丁三醇治疗对胎儿娩出后瘢痕子宫阴道分娩产妇产后出血量、产程时间及不良反应的影响[J].中国妇幼保健,2018,33(13):2919-2922.
[9] 王起兰,林姝,程卫平,等.引导硬膜外分娩镇痛产妇卧位调节对胎儿枕后位影响的研究[J].中国实用护理杂志,2018,34(11):809-813.
[10] Skret-Magier?o J,Barnas E,Sek-K?ebukowska B,et al.Intracranial hematoma as the cause of headache after subarachnoid anesthesia for cesarean section-a case report[J].Ginekol Pol,2014,85(1):58-61.
[11] 姚秀娟,陈祥义,张如意,等.子宫颈产生黏液的复层上皮内病变一例[J].中华妇产科杂志,2018,53(5):340.
[12] 李雪莲,汪洋,戴婉波,等.胎盘早剥65例临床分析[J].中国妇幼健康研究,2016,27(5):640-642.
[13] Craig J R,Collins C L,Bunter K L,et al.Poorer lifetime growth performance of gilt progeny compared with sow progeny is largely due to weight differences at birth and reduced growth in the preweaning period,and is not improved by progeny segregation after weaning[J].J Anim Sci,2017,95(11):4904-4916.
[14] 刘石萍,邢会美,苏世萍,等.单纯空腹血糖升高的妊娠期糖尿病患者的妊娠结局及其影响因素[J].中华围产医学杂志,2017,20(11):796-800.
[15] 李媚芳,张远军,黄媛.连续硬膜外分娩镇痛对初产妇产后压力性尿失禁的影响[J].中国现代医生,2017,55(17):102-104.120.