急产产妇的院前救治探讨
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摘要
目的探讨院前急救过程中对急产产妇的救治和效果。方法选择镇江市急救中心2017-01-01至2018-12-31救治的急产产妇,采用随机数字表法分为观察组和对照组,分别采用不同的院前救治流程与措施,观察急救情况,同时分析相关的影响因素。结果共纳入76例急产产妇,年龄25～44岁,平均(28.3±4.8)岁,入院孕周为37～40~(+3)周;初产妇55例,经产妇21例。其中观察组40例,院外分娩1例(2.5%);对照组36例,院外分娩9例(25.0%),两组比较差异有统计学意义(P<0.05)。院前救治的孕产妇发生急产主要与年龄、分娩史(距离上次分娩时间)等因素有关(P<0.05)。年龄>35岁、有2年以上分娩史的经产妇是引起急产的独立高危因素(P<0.05)。结论产妇院外急产时,尽早的院前干预措施可降低院前分娩率,同时建议经产妇、居住边远的孕产妇临产期临近应及时住院。
Objective The objective of this study was to investigate the treatment and effect of parturient mothers in prehospital emergency care. Methods Parturient women admitted into the Emergency Medical Center of Zhenjiang between January 1 st2017 and December 31 st 2018 were randomly divided into two groups: observation group and control group. The related first aid situation was observed, and at the same time, the related influencing factors were analyzed. Results A total of 76 parturient mothers, aged between25 and 44 years, with an average of(28.3±4.8) years, were admitted to hospital for 37 and 40~(+3) weeks; 55 primiparae and 21 multipara.There were 40 cases in observation group, 1 case(2.5%) of out-of-hospital delivery; and 36 cases in control group, 9 cases(25.0%) of outof-hospital delivery. There was significant difference between the two groups(P<0.05). The occurrence of parturition before hospital was mainly related to age, history of delivery(time from the last delivery) and other factors(P<0.05). Multipara with age>35 years old and having a history of delivery for more than 2 years were independent risk factors for acute labor(P<0.05). Conclusions The early prehospital interventions can reduce the rate of pre-hospital delivery when parturients have an emergency delivery outside the hospital. It is also suggested that multipara and delivery women living in remote areas should be hospitalized in time when they are about to give birth.
Objective The objective of this study was to investigate the treatment and effect of parturient mothers in prehospital emergency care. Methods Parturient women admitted into the Emergency Medical Center of Zhenjiang between January 1 st2017 and December 31 st 2018 were randomly divided into two groups: observation group and control group. The related first aid situation was observed, and at the same time, the related influencing factors were analyzed. Results A total of 76 parturient mothers, aged between25 and 44 years, with an average of(28.3±4.8) years, were admitted to hospital for 37 and 40~(+3) weeks; 55 primiparae and 21 multipara.There were 40 cases in observation group, 1 case(2.5%) of out-of-hospital delivery; and 36 cases in control group, 9 cases(25.0%) of outof-hospital delivery. There was significant difference between the two groups(P<0.05). The occurrence of parturition before hospital was mainly related to age, history of delivery(time from the last delivery) and other factors(P<0.05). Multipara with age>35 years old and having a history of delivery for more than 2 years were independent risk factors for acute labor(P<0.05). Conclusions The early prehospital interventions can reduce the rate of pre-hospital delivery when parturients have an emergency delivery outside the hospital. It is also suggested that multipara and delivery women living in remote areas should be hospitalized in time when they are about to give birth.
引文
[1]雷丽华,冯云华,李风英.院前电话指导急产产妇自救的重要性探讨[J].基层医学论坛,2018,22(25):3600-3601.DOI:10.19435/j.1672-1721.2018.25.069.
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[5]Pourette D, Pierlovisi C,Randriantsara R, et al. Avoiding a"big"baby:Local perceptions and social responses toward childbirth-related complications in Menabe, Madagascar[J]. Soc Sci Med, 2018,218(10):52-61. DOI:10.1016/j.socscimed.2018.10.002.
[6]Storeng KT, Mishra A. Politics and practices of global health:Critical ethnographies of health systems[J].Glob Public Health, 2014, 9(8):858-864. DOI:10.1080/17441692.2014.941901.
[7]邢雯茜.院前急救电话指导分娩对孕产妇急产的影响[J].山西医药杂志,2017,46(3):352-353.DOI:10.3969/j.issn.0253-9926.2017.03.045.
[8]郭华燕,肖云珍,蒋玲玲.探讨急产的院前急救及护理体会[J].中国医药指南,2018,16(15):257-258. DOI:10.15912/j.cnki.gocm.2018.15.202.
[9]李敏.产妇急产的影响因素及其预防方案探讨[J].西部医学,2015,27(5):748-750. DOI:10.3969/j.issn.1672-3511.2015.05.036.
[10]于艳彬,魏文峰,卢敏,等.集束管理对急产母婴结局的影响[J].护理研究,2016,30(2):218-219. DOI:10.3969/j.issn.1009-6493.2016.02.036.
[11]陈云,杨帅,何亚,等.自发性早产病人发生急产的高危因素分析[J].护理研究,2015,29(30):3797-3798. DOI:10.3969/j.issn.1009-6493.2015.30.033.
[12]王建红.院前急救护理对26例急产孕妇的影响[J].临床医学研究与实践,2017, 2(26):176-177. DOI:10.19347/j.cnki.2096-1413.201726087.
[13]蔡慧华,何援利,覃爱开,等.急产的相关因素分析及预防措施[J].广东医学,2014, 35(3):407-409. DOI:10.13820/j.cnki.gdyx.2014.03.033.
[14] Kavosi Z, Keshtkaran A, Setoodehzadeh F, et al. A comparison of mothers'quality of life after normal vaginal,cesarean, and water birth deliveries[J]. Int J Community Based Nurs Midwifery, 2015,3(3):198-204.
[15] Graham W J, Hundley V, McCheyne A L, et al. An investigation of women's involvement in the decision to deliver by caesarean section[J]. Br J Obstet Gynaecol,1999,106(3):213-220. DOI:10.1111/j.1471-0528.1999.tb08233.x.
[2]郑慧娟,沈鸣雁,赵晶,等.急产的早期识别与标准化处理流程的应用[J].中华急诊医学杂志,2018,27(11):1291-1293.DOI:10.3760/cma.j.issn.1671-0282.2018.11.023.
[3]Martin C R,Jomeen J.Assessment of quality of life during pregnancy and in the postnatal period[M].Springer New York,2010:2411-2422.DOI:10.1007/978-0-387-78665-0_141.
[4]Oliveira M F D,Parker L,Ahn H,et al.Maternal predictors for quality of life during the postpartum in Brazilian mothers[J].Health,2015,7(3):371-380.DOI:10.4236/health.2015.73042.Pourette D,Pierlovisi C,Randriantsara R,et al.Avoiding a"big"baby:Local perceptions and social responses toward childbirth-related complications in Menabe,Madagascar[J].Soc Sci Med,2018,218(10):52-61.DOI:10.1016/j.socscimed.2018.10.002.Storeng K T,Mishra A.Politics and practices of global health:Critical ethnographies of health systems[J].Glob Public Health,2014,9(8):858-864.DOI:10.1080/17441692.2014.941901.邢雯茜.院前急救电话指导分娩对孕产妇急产的影响[J].山西医药杂志,2017,46(3):352-353.DOI:10.3969/j.issn.0253-9926.2017.03.045.郭华燕,肖云珍,蒋玲玲.探讨急产的院前急救及护理体会[J].中国医药指南,2018,16(15):257-258.DOI:10.15912/j.cnki.gocm.2018.15.202.李敏.产妇急产的影响因素及其预防方案探讨[J].西部医学,2015,27(5):748-750.DOI:10.3969/j.issn.1672-3511.2015.05.036.于艳彬,魏文峰,卢敏,等.集束管理对急产母婴结局的影响[J].护理研究,2016,30(2):218-219.DOI:10.3969/j.issn.1009-6493.2016.02.036.陈云,杨帅,何亚,等.自发性早产病人发生急产的高危因素分析[J].护理研究,2015,29(30):3797-3798.DOI:10.3969/j.issn.1009-6493.2015.30.033.王建红.院前急救护理对26例急产孕妇的影响[J].临床医学研究与实践,2017,2(26):176-177.DOI:10.19347/j.cnki.2096-1413.201726087.蔡慧华,何援利,覃爱开,等.急产的相关因素分析及预防措施[J].广东医学,2014,35(3):407-409.DOI:10.13820/j.cnki.gdyx.2014.03.033.Kavosi Z,Keshtkaran A,Setoodehzadeh F,et al.Acomparison of mothers'quality of life after normal vaginal,cesarean,and water birth deliveries[J].Int J Community Based Nurs Midwifery,2015,3(3):198-204.Graham W J,Hundley V,McCheyne A L,et al.An investigation of women's involvement in the decision to deliver by caesarean section[J].Br J Obstet Gynaecol,1999,106(3):213-220.DOI:10.1111/j.1471-0528.1999.tb08233.x.health.2015.73042.Pourette D, Pierlovisi C, Randriantsara R, et al. Avoiding a"big"baby:Local perceptions and social responses toward childbirth-related complications in Menabe, Madagascar[J]. Soc Sci Med, 2018, 218(10):52-61. DOI:10.1016/j.socscimed.2018.10.002.Storeng K T, Mishra A. Politics and practices of global health:Critical ethnographies of health systems[J].Glob Public Health, 2014, 9(8):858-864. DOI:10.1080/17441692.2014.941901.邢雯茜.院前急救电话指导分娩对孕产妇急产的影响[J].山西医药杂志, 2017, 46(3):352-353. DOI:10.3969/j.issn.0253-9926.2017.03.045.郭华燕,肖云珍,蒋玲玲.探讨急产的院前急救及护理体会[J].中国医药指南, 2018, 16(15):257-258. DOI:10.15912/j.cnki.gocm.2018.15.202.李敏.产妇急产的影响因素及其预防方案探讨[J].西部医学, 2015, 27(5):748-750. DOI:10.3969/j.issn.1672-3511.2015.05.036.于艳彬,魏文峰,卢敏,等.集束管理对急产母婴结局的影响[J].护理研究, 2016, 30(2):218-219. DOI:[5][6][7][8][9][10]10.3969/j.issn.1009-6493.2016.02.036.陈云,杨帅,何亚,等.自发性早产病人发生急产的高危因素分析[J].护理研究, 2015, 29(30):3797-3798. DOI:10.3969/j.issn.1009-6493.2015.30.033.王建红.院前急救护理对26例急产孕妇的影响[J].临床医学研究与实践, 2017, 2(26):176-177. DOI:10.19347/j.cnki.2096-1413.201726087.蔡慧华,何援利,覃爱开,等.急产的相关因素分析及预防措施[J].广东医学, 2014, 35(3):407-409. DOI:10.13820/j.cnki.gdyx.2014.03.033.Kavosi Z, Keshtkaran A, Setoodehzadeh F, et al. A comparison of mothers'quality of life after normal vaginal,cesarean, and water birth deliveries[J]. Int J Community Based Nurs Midwifery, 2015, 3(3):198-204.Graham W J, Hundley V, McCheyne A L, et al. An investigation of women's involvement in the decision to deliver by caesarean section[J]. Br J Obstet Gynaecol,1999, 106(3):213-220. DOI:10.1111/j.1471-0528.1999.tb08233.x.[11][12][13][14][15]health.2015.73042.
[5]Pourette D, Pierlovisi C,Randriantsara R, et al. Avoiding a"big"baby:Local perceptions and social responses toward childbirth-related complications in Menabe, Madagascar[J]. Soc Sci Med, 2018,218(10):52-61. DOI:10.1016/j.socscimed.2018.10.002.
[6]Storeng KT, Mishra A. Politics and practices of global health:Critical ethnographies of health systems[J].Glob Public Health, 2014, 9(8):858-864. DOI:10.1080/17441692.2014.941901.
[7]邢雯茜.院前急救电话指导分娩对孕产妇急产的影响[J].山西医药杂志,2017,46(3):352-353.DOI:10.3969/j.issn.0253-9926.2017.03.045.
[8]郭华燕,肖云珍,蒋玲玲.探讨急产的院前急救及护理体会[J].中国医药指南,2018,16(15):257-258. DOI:10.15912/j.cnki.gocm.2018.15.202.
[9]李敏.产妇急产的影响因素及其预防方案探讨[J].西部医学,2015,27(5):748-750. DOI:10.3969/j.issn.1672-3511.2015.05.036.
[10]于艳彬,魏文峰,卢敏,等.集束管理对急产母婴结局的影响[J].护理研究,2016,30(2):218-219. DOI:10.3969/j.issn.1009-6493.2016.02.036.
[11]陈云,杨帅,何亚,等.自发性早产病人发生急产的高危因素分析[J].护理研究,2015,29(30):3797-3798. DOI:10.3969/j.issn.1009-6493.2015.30.033.
[12]王建红.院前急救护理对26例急产孕妇的影响[J].临床医学研究与实践,2017, 2(26):176-177. DOI:10.19347/j.cnki.2096-1413.201726087.
[13]蔡慧华,何援利,覃爱开,等.急产的相关因素分析及预防措施[J].广东医学,2014, 35(3):407-409. DOI:10.13820/j.cnki.gdyx.2014.03.033.
[14] Kavosi Z, Keshtkaran A, Setoodehzadeh F, et al. A comparison of mothers'quality of life after normal vaginal,cesarean, and water birth deliveries[J]. Int J Community Based Nurs Midwifery, 2015,3(3):198-204.
[15] Graham W J, Hundley V, McCheyne A L, et al. An investigation of women's involvement in the decision to deliver by caesarean section[J]. Br J Obstet Gynaecol,1999,106(3):213-220. DOI:10.1111/j.1471-0528.1999.tb08233.x.