护理行为感知在前置胎盘剖宫产手术中的意义
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摘要
为探讨护理行为感知在前置胎盘剖宫产手术患者中应用的价值,本研究选取我院拟实施剖宫产的前置胎盘妊娠妇女90例,收集时间为2015年1月至2017年4月,随机将其分为观察组(手术期护理实施护理行为感知模式)和常规组(常规护理模式)各45例,并对比两组产妇术中出血量、术后24 h出血量、新生儿基本情况及产妇焦虑情绪变化情况。研究发现,观察组产妇的术中、术后24 h出血量均显著低于常规组,差异具有统计学意义(p<0.05);观察组和常规组的新生儿体质量差异无统计学意义(p>0.05);观察组新生儿1 min及5 min Apgar评分高于常规组,差异具有统计学意义(p<0.05);观察组的产后并发症发生概率为15.56%,显著低于常规组的35.56%,差异具有统计学意义(p<0.05);产前24 h、产后24 h,观察组的HAMA评分均低于常规组,差异具有统计学意义(p<0.05)。结果表明,护理行为感知在前置胎盘剖宫产手术患者中应用有利于减轻产妇的焦虑情绪、减少术中及术后出血量,提高新生儿的Apgar评分,并降低手术并发症的风险。
To explore the value of the application of nursing behavior perception in the patients undergoing cesarean section of placenta previa, in this study, 90 pregnant women with placenta previa who were scheduled to undergo caesarean section in our hospital were selected. The collection time was from January 2015 to April 2017, and they were randomly divided into observation group(nursing behavior perception mode during operation) and routine group(routine nursing mode), with 45 cases in each group. We compared the intraoperative blood loss, bleeding volume 24 h after operation, the basic situation of newborns, and the maternal anxiety changes between the two groups. The study found that the intraoperative and postoperative 24 h bleeding volume in the observation group were significantly lower than that in the routine group, and the difference was statistically significant(p<0.05). There was no significant difference in the newborns body mass between the observation group and the routine group(p>0.05). The Apgar scores of the 1 min and 5 min neonates in the observation group were higher than those in the routine group, and the difference was statistically significant(p<0.05). The incidence of postpartum complications in the observation group was 15.56%,which was obviously lower than that in the routine group(35.56%), and the difference was statistically significant(p<0.05). The HAMA scores of the observation group were lower than those of the routine group 24 hours before and24 hours after delivery, and the difference was statistically significant(p<0.05). The results showed that the application of nursing behavioral perception in patients undergoing placenta previa caesarean section would be helpful to alleviate maternal anxiety, reduce the amount of intraoperative and postoperative bleeding, improve the Apgar score of newborns, and reduce the risk of surgical complications.
To explore the value of the application of nursing behavior perception in the patients undergoing cesarean section of placenta previa, in this study, 90 pregnant women with placenta previa who were scheduled to undergo caesarean section in our hospital were selected. The collection time was from January 2015 to April 2017, and they were randomly divided into observation group(nursing behavior perception mode during operation) and routine group(routine nursing mode), with 45 cases in each group. We compared the intraoperative blood loss, bleeding volume 24 h after operation, the basic situation of newborns, and the maternal anxiety changes between the two groups. The study found that the intraoperative and postoperative 24 h bleeding volume in the observation group were significantly lower than that in the routine group, and the difference was statistically significant(p<0.05). There was no significant difference in the newborns body mass between the observation group and the routine group(p>0.05). The Apgar scores of the 1 min and 5 min neonates in the observation group were higher than those in the routine group, and the difference was statistically significant(p<0.05). The incidence of postpartum complications in the observation group was 15.56%,which was obviously lower than that in the routine group(35.56%), and the difference was statistically significant(p<0.05). The HAMA scores of the observation group were lower than those of the routine group 24 hours before and24 hours after delivery, and the difference was statistically significant(p<0.05). The results showed that the application of nursing behavioral perception in patients undergoing placenta previa caesarean section would be helpful to alleviate maternal anxiety, reduce the amount of intraoperative and postoperative bleeding, improve the Apgar score of newborns, and reduce the risk of surgical complications.
引文
A nanth C.V.,Demissie K.,Smulian J.C.,and Vintzileos A.M.,2001,Relationship among placenta previa,fetal growth restriction,and preterm delivery:a population-based study,Obstet.Gynecol.,98(2):299-306
Bao Y.,Xu C.,Qu X.,Quan S.,Dong Y.,and Ying H.,2016,Risk factors for transfusion in cesarean section deliveries at a tertiary hospital,Transfusion,56(8):2062-2068
Cao Z.Y.,ed.,2005,Chinese obstetrics and gynecology,People's Medical Publishing House,Beijing,China,pp.422(曹泽毅,主编,2005,中华妇产科学,人民卫生出版社,中国,北京,pp.422)
Cheng Y.,2017,The application of the individualized nursing intervention in patients with placenta previa,Yiyao Qianyan(Journal of Frontiers of Medicine),7(6):57-58(程瑶,2017,个性化护理干预在前置胎盘患者护理中的应用探究,医药前沿,7(6):57-58)
Choi S.K.,Shin J.E.,and Kim S.J.,2015,Serial change in cervical length and the risk of emergent cesarean delivery in placenta previa,Placenta,36(9):A46
E L.L.,Hong J.F.,and Xie L.F.,2016,Study on registered nurses'behaviors of helping hospitalized patients'smoking cessation based on the Theory of Planned Behavior(TPB),Zhonghua Jibing Kongzhi Zazhi(Chinese Journal of Disease Control&Prevention),20(5):443-446(鄂丽丽,洪静芳,谢伦芳,2016,基于计划行为理论注册护士帮助住院患者戒烟行为的研究,中华疾病控制杂志,20(5):443-446)
Li Q.,Wang Y.,Wang J.,Gao L.Q.,Kang Y.J.,and Zhang L.W.,2017,Clinical application of circumferential uterine lower ring suture in cesarean section of placenta previa,Zhongguo Shiyong Fuke Yu Chanke Zazhi(Chinese Journal of Practical Gynecology and Obstetrics),28(7):734-737(李青,汪艳,王婧,高柳琴,康永军,张力维,2017,宫颈子宫下段环形缝合术在前置胎盘剖宫产术中出血的临床应用,中国实用妇科与产科杂志,28(7):734-737)
Liu Z.Y.,Yu L.,Yi X.Y.,and Wei X.F.,2016,The occlusion of abdominal aorta with balloon to control bleeding during operation for dangerous placenta previa associated with placenta accrete:preliminary results in 22 cases,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),25(7):624-627(刘智勇,余雷,易小宇,韦小芳,2016,球囊阻断腹主动脉控制凶险性前置胎盘并胎盘植入剖宫产术中出血22例,介入放射学杂志,25(7):624-627)
Mohammadi S.,Essén B.,Fallahian M.,Taheripanah R.,Saleh Gargari S.,and K覿llest覽l C.,2016,Maternal near-miss at university hospitals with cesarean overuse:an incident case-control study,Acta Obstet.Gynecol.Scand.,95(7):777-786
Qiu Z.,Hu J.,Wu J.,and Chen L.,2017,Prophylactic temporary abdominal aorta balloon occlusion in women with placenta previa accretism during late gestation,Medicine,96(46):e8681
Rosenberg T.,Pariente G.,Sergienko R.,Wiznitzer A.,and Sheiner E.,2011,Critical analysis of risk factors and outcome of placenta previa,Arch.Gynecol.Obstet.,284(1):47-51
Song P.,and Wu N.,2017,The application of temporary balloon occlusion technique in performing cesarean section for patients with pernicious placenta previa,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),26(5):451-454(宋鹏,吴宁,2017,球囊临时阻断技术在凶险性前置胎盘剖宫产术中的应用,介入放射学杂志,26(5):451-454)
Vojtech J.,Pock R.,Palasova K.,Haslik L.,and Krofta L.,2015,P03.08:Placenta previa accreta after previous Caesarean section:correlation of ultrasound images,MRI and histology specimens in a series of cases,Ultrasound in Obstetrics&Gynecology,46(S1):130
Wu S.Y.,Li L.H.,and Chen M.L.,2015,Observation of effect improvement of nursing interference in placenta previa expectant management,Zhongguo Yiyao Kexue(China Medicine and Pharmacy),5(10):115-117(吴淑瑶,李丽华,陈妙玲,2015,护理干预对前置胎盘期待疗法的提高效果观察,中国医药科学,5(10):115-117)
Xing L.,Yuan C.J.,and Wu N.,2016,Preset balloon catheter for cesarean section in patients with dangerous placenta previa complicated by placenta accreta:discussion on its nursing care,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),25(2):175-177(邢丽,袁婵娟,吴宁,2016,预置球囊导管在凶险性前置胎盘伴胎盘植入剖宫产术中的护理,介入放射学杂志,25(2):175-177)
Ye S.X.,Wang L.J.,Yang X.N.,Qin C.,Yu D.D.,Li Y.Y.,and Feng J.P.,2017,Application effect of personalized nursing in patients with placenta previa,Zhongguo Weisheng Biaozhun Guanli(China Health Standards Management),8(15):174-176(叶少欣,王丽娟,阳杏妮,覃晨,于丹丹,李盈盈,冯锦屏,2017,个性化护理在前置胎盘患者护理中的应用效果,中国卫生标准管理,8(15):174-176)
Yeniel A.O.,Ergenoglu A.M.,Itil I.M.,Askar N.,and Meseri R.,2012,Effect of placenta previa on fetal growth restriction and stillbirth,Arch.Gynecol.Obstet.,286(2):295-298
Zhang X.Q.,Cheng X.W.,Wang L.F.,and Xue M.,2016,Perioperative nursing care of patients with dangerous placenta previa treated with uterine balloon,Zhonghua Huli Zazhi(Journal of Chinese Nursing),51(11):1317-1319(张小青,程湘玮,王兰芳,薛梅,2016,子宫填塞球囊在凶险性前置胎盘剖宫产术中应用的护理,中华护理杂志,51(11):1317-1319)
Zhang Z.Y.,Deng L.Y.,Lou J.Y.,and Peng B.,2017,Clinical analysis of 38 cases of sinus placenta with placenta and cesarean section during cesarean section,Shiyong Fuchanke Zazhi(Practical Journal of Obstetrics and Gynecology),33(1):65-68(张振宇,邓莉芸,楼江燕,彭冰,2017,凶险性前置胎盘伴胎盘植入剖宫产术中应用髂内动脉球囊阻断术38例临床分析,实用妇产科杂志,33(1):65-68)
Zhong X.T.,and Hao G.R.,2015,Study on the situation of difference in perception and the related factors in caring behaviors between nurses and patients,Zhonghua Xingwei Yixue Yu Naokexue Zazhi(Journal of Chinese Behavioral Medicine and Brain Science),24(6):560-562(钟晓彤,郝桂荣,2015,护患感知关怀行为差异现状及影响因素,中华行为医学与脑科学杂志,24(6):560-562)
Bao Y.,Xu C.,Qu X.,Quan S.,Dong Y.,and Ying H.,2016,Risk factors for transfusion in cesarean section deliveries at a tertiary hospital,Transfusion,56(8):2062-2068
Cao Z.Y.,ed.,2005,Chinese obstetrics and gynecology,People's Medical Publishing House,Beijing,China,pp.422(曹泽毅,主编,2005,中华妇产科学,人民卫生出版社,中国,北京,pp.422)
Cheng Y.,2017,The application of the individualized nursing intervention in patients with placenta previa,Yiyao Qianyan(Journal of Frontiers of Medicine),7(6):57-58(程瑶,2017,个性化护理干预在前置胎盘患者护理中的应用探究,医药前沿,7(6):57-58)
Choi S.K.,Shin J.E.,and Kim S.J.,2015,Serial change in cervical length and the risk of emergent cesarean delivery in placenta previa,Placenta,36(9):A46
E L.L.,Hong J.F.,and Xie L.F.,2016,Study on registered nurses'behaviors of helping hospitalized patients'smoking cessation based on the Theory of Planned Behavior(TPB),Zhonghua Jibing Kongzhi Zazhi(Chinese Journal of Disease Control&Prevention),20(5):443-446(鄂丽丽,洪静芳,谢伦芳,2016,基于计划行为理论注册护士帮助住院患者戒烟行为的研究,中华疾病控制杂志,20(5):443-446)
Li Q.,Wang Y.,Wang J.,Gao L.Q.,Kang Y.J.,and Zhang L.W.,2017,Clinical application of circumferential uterine lower ring suture in cesarean section of placenta previa,Zhongguo Shiyong Fuke Yu Chanke Zazhi(Chinese Journal of Practical Gynecology and Obstetrics),28(7):734-737(李青,汪艳,王婧,高柳琴,康永军,张力维,2017,宫颈子宫下段环形缝合术在前置胎盘剖宫产术中出血的临床应用,中国实用妇科与产科杂志,28(7):734-737)
Liu Z.Y.,Yu L.,Yi X.Y.,and Wei X.F.,2016,The occlusion of abdominal aorta with balloon to control bleeding during operation for dangerous placenta previa associated with placenta accrete:preliminary results in 22 cases,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),25(7):624-627(刘智勇,余雷,易小宇,韦小芳,2016,球囊阻断腹主动脉控制凶险性前置胎盘并胎盘植入剖宫产术中出血22例,介入放射学杂志,25(7):624-627)
Mohammadi S.,Essén B.,Fallahian M.,Taheripanah R.,Saleh Gargari S.,and K覿llest覽l C.,2016,Maternal near-miss at university hospitals with cesarean overuse:an incident case-control study,Acta Obstet.Gynecol.Scand.,95(7):777-786
Qiu Z.,Hu J.,Wu J.,and Chen L.,2017,Prophylactic temporary abdominal aorta balloon occlusion in women with placenta previa accretism during late gestation,Medicine,96(46):e8681
Rosenberg T.,Pariente G.,Sergienko R.,Wiznitzer A.,and Sheiner E.,2011,Critical analysis of risk factors and outcome of placenta previa,Arch.Gynecol.Obstet.,284(1):47-51
Song P.,and Wu N.,2017,The application of temporary balloon occlusion technique in performing cesarean section for patients with pernicious placenta previa,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),26(5):451-454(宋鹏,吴宁,2017,球囊临时阻断技术在凶险性前置胎盘剖宫产术中的应用,介入放射学杂志,26(5):451-454)
Vojtech J.,Pock R.,Palasova K.,Haslik L.,and Krofta L.,2015,P03.08:Placenta previa accreta after previous Caesarean section:correlation of ultrasound images,MRI and histology specimens in a series of cases,Ultrasound in Obstetrics&Gynecology,46(S1):130
Wu S.Y.,Li L.H.,and Chen M.L.,2015,Observation of effect improvement of nursing interference in placenta previa expectant management,Zhongguo Yiyao Kexue(China Medicine and Pharmacy),5(10):115-117(吴淑瑶,李丽华,陈妙玲,2015,护理干预对前置胎盘期待疗法的提高效果观察,中国医药科学,5(10):115-117)
Xing L.,Yuan C.J.,and Wu N.,2016,Preset balloon catheter for cesarean section in patients with dangerous placenta previa complicated by placenta accreta:discussion on its nursing care,Jieru Fangshexue Zazhi(Journal of Interventional Radiology),25(2):175-177(邢丽,袁婵娟,吴宁,2016,预置球囊导管在凶险性前置胎盘伴胎盘植入剖宫产术中的护理,介入放射学杂志,25(2):175-177)
Ye S.X.,Wang L.J.,Yang X.N.,Qin C.,Yu D.D.,Li Y.Y.,and Feng J.P.,2017,Application effect of personalized nursing in patients with placenta previa,Zhongguo Weisheng Biaozhun Guanli(China Health Standards Management),8(15):174-176(叶少欣,王丽娟,阳杏妮,覃晨,于丹丹,李盈盈,冯锦屏,2017,个性化护理在前置胎盘患者护理中的应用效果,中国卫生标准管理,8(15):174-176)
Yeniel A.O.,Ergenoglu A.M.,Itil I.M.,Askar N.,and Meseri R.,2012,Effect of placenta previa on fetal growth restriction and stillbirth,Arch.Gynecol.Obstet.,286(2):295-298
Zhang X.Q.,Cheng X.W.,Wang L.F.,and Xue M.,2016,Perioperative nursing care of patients with dangerous placenta previa treated with uterine balloon,Zhonghua Huli Zazhi(Journal of Chinese Nursing),51(11):1317-1319(张小青,程湘玮,王兰芳,薛梅,2016,子宫填塞球囊在凶险性前置胎盘剖宫产术中应用的护理,中华护理杂志,51(11):1317-1319)
Zhang Z.Y.,Deng L.Y.,Lou J.Y.,and Peng B.,2017,Clinical analysis of 38 cases of sinus placenta with placenta and cesarean section during cesarean section,Shiyong Fuchanke Zazhi(Practical Journal of Obstetrics and Gynecology),33(1):65-68(张振宇,邓莉芸,楼江燕,彭冰,2017,凶险性前置胎盘伴胎盘植入剖宫产术中应用髂内动脉球囊阻断术38例临床分析,实用妇产科杂志,33(1):65-68)
Zhong X.T.,and Hao G.R.,2015,Study on the situation of difference in perception and the related factors in caring behaviors between nurses and patients,Zhonghua Xingwei Yixue Yu Naokexue Zazhi(Journal of Chinese Behavioral Medicine and Brain Science),24(6):560-562(钟晓彤,郝桂荣,2015,护患感知关怀行为差异现状及影响因素,中华行为医学与脑科学杂志,24(6):560-562)