导乐陪伴、自由体位、腰-硬联合麻醉分娩镇痛联合应用对促进自然分娩的效果观察
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摘要
目的:分析导乐陪伴、自由体位、腰-硬联合麻醉分娩镇痛联合应用对促进自然分娩的效果。方法:将2017年4月-2019年3月住院分娩产妇根据自愿参加的原则随机分为观察组、镇痛组、导乐+体位组,每组200例,观察组给予导乐陪伴、自由体位及腰-硬联合麻醉镇痛。镇痛组只给予腰-硬联合麻醉镇痛,导乐+体位组采取导乐陪伴加自由体位分娩。观察三组产妇的疼痛评分(VAS)、麻醉药用量、产后2 h出血量、总产程时间、分娩方式、新生儿Apgar评分及新生儿窒息情况。结果:观察组疼痛评分(2.69±0.42)分,产后2 h出血(149.57±26.34)ml,麻醉药用量(34.32±7.56)ml,新生儿Apgar评分(9.51±0.25)分,均优于镇痛组及/或导乐+体位组,差异有统计学意义(P<0.05);观察组总产程用时较镇痛组及导乐+体位组更短,且自然分娩率更高,新生儿窒息发生率更低(P<0.05)。结论:导乐陪伴、自由体位、腰-硬联合麻醉分娩镇痛联合应用,能有效缓解孕妇分娩疼痛,缩短产程时间,减少产后出血,提高自然分娩率,降低剖宫产率,促进自然分娩。
Objective:To analyze the effect of Doula accompaniment,free posture,combined spinal-epidural anesthesia for labor analgesia on promoting natural delivery.Method:From April 2017 to March 2018,600 cases of parturient women in our hospital were divided into the observation group,the analgesia group,the Doula+body position group according to the order of admission,200 cases in each group.The observation group was given Doula,free position and combined spinal epidural analgesia,the analgesic group was given spinal-epidural anesthesia for analgesia,Doula+body position group was given doula accompanied and free position.Pain score(VAS),postpartum hemorrhage 2 hours,anesthetic dosage,neonatal Apgar score,total duration of labor,mode of delivery and neonatal asphyxia of the 3 groups were observed.Result:The pain score was(2.69±0.42)points,postpartum hemorrhage of 2 h was(149.57±26.34)ml, anesthetic dosage was(34.32±7.56)ml and neonatal Apgar score was(9.51±0.25)points in the observation group,better than those in the analgesia group and Doula+body position group,there were statistical significance(P<0.05).The total labor duration of observation group was shorter than that of the analgesia group and Doula+body posture group,and the natural delivery rate was higher,and the incidence of neonatal asphyxia was lower(P<0.05).Conclusion:Doula accompanying,free posture and combined spinal-epidural anesthesia for labor analgesia can effectively alleviate labor pain,shorten labor time,reduce postpartum hemorrhage and analgesic dosage,and improve the natural delivery rate.
Objective:To analyze the effect of Doula accompaniment,free posture,combined spinal-epidural anesthesia for labor analgesia on promoting natural delivery.Method:From April 2017 to March 2018,600 cases of parturient women in our hospital were divided into the observation group,the analgesia group,the Doula+body position group according to the order of admission,200 cases in each group.The observation group was given Doula,free position and combined spinal epidural analgesia,the analgesic group was given spinal-epidural anesthesia for analgesia,Doula+body position group was given doula accompanied and free position.Pain score(VAS),postpartum hemorrhage 2 hours,anesthetic dosage,neonatal Apgar score,total duration of labor,mode of delivery and neonatal asphyxia of the 3 groups were observed.Result:The pain score was(2.69±0.42)points,postpartum hemorrhage of 2 h was(149.57±26.34)ml, anesthetic dosage was(34.32±7.56)ml and neonatal Apgar score was(9.51±0.25)points in the observation group,better than those in the analgesia group and Doula+body position group,there were statistical significance(P<0.05).The total labor duration of observation group was shorter than that of the analgesia group and Doula+body posture group,and the natural delivery rate was higher,and the incidence of neonatal asphyxia was lower(P<0.05).Conclusion:Doula accompanying,free posture and combined spinal-epidural anesthesia for labor analgesia can effectively alleviate labor pain,shorten labor time,reduce postpartum hemorrhage and analgesic dosage,and improve the natural delivery rate.
引文
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[2]厉跃红,吴娜,庄薇,等.分娩球配合自由体位助产对初产妇产痛、分娩控制感及妊娠结局的影响[J].中华护理杂志,2017,48(9):793-796.
[3]吴菊香.心理护理和精神支持在分娩过程中的作用[J].中华医学丛刊杂志,2002,2(7):77.
[4]范振玲.100例产妇对分娩镇痛认知程度的调查[J].中国疼痛医学,2001,7(3):140-144.
[5]张康.全程导乐陪伴分娩在初产妇无痛分娩中的应用效果观察[J].临床医药文献杂志,2015,2(33):6799-6802.
[6]袁华.全程导乐陪伴分娩对初产妇产后抑郁、焦虑情绪的影响[J].中国医科大学学报,2013,42(10):937-939.
[7]黄醒华,项小英,沈汝棡,等.自然分娩的产时服务模式探讨[J].中华妇产科杂志,2003,38(7):385-387.
[8]吕玉美.自由体位对足月胎膜早破孕妇分娩结局的影响[J].海南医学,2012,23(24):62-63.
[9]杜新青.采用自由体位与传统卧位对分娩影响的临床观察[J].河北医药,2014,36(13):1956-1958.
[10]李秋芬,王爱玲,马传琴,等.第一产程导乐陪伴与自由体位联合应用临床研究[J].中国妇幼保健,2004,19(10):75-76.
[11]胡灵群.从“无痛分娩中国行”看中国的分娩镇痛[J].临床麻醉学杂志,2013,29(2):205-208.
[12]Bodner-Adler B,Bodner K,Kimberger O,et al.The effect of epiduralanalgesia on obstetric lacerations and neonatal outcome during spontaneous vaginal delivery[J].Arch Gynecol Obstet,2003,267(3):130-133.
[13]王丽.分娩镇痛联合导乐陪伴对分娩质量的影响[J].蚌埠医学院学报,2012,37(8):1004-1006.