无保护会阴分娩法对母婴结局的影响  

Effect of delivery without perineum protection on the maternal and neonatal outcomes

作　　者：吴吉梅[1] 盛文伟[2] 朱卫国[3] 高健[4] 吕述彦[5] 王凤琴[5] 

机构地区：[1]江苏省淮安市妇幼保健医院科教科,223002 [2]南京医科大学附属淮安第一医院超声科,223300 [3]南京医科大学附属淮安第一医院放疗科,,223300 [4]南京医科大学附属淮安第一医院统计室,,223300 [5]南京医科大学附属淮安第一医院产科,,223300

出　　处：《中华现代护理杂志》2014年第11期1269-1273,共5页Chinese Journal of Modern Nursing

基　　金：江苏省淮安市科技支撑计划（HAS2011029）

摘　　要：目的：探讨无保护会阴分娩法对母婴结局的影响。方法对2012年7月1日-2013年2月1日分娩的有完整随访资料的701位产妇进行回顾性分析，其中无保护会阴法208人，常规会阴切开分娩法493人，分别对产时、产后第1天、第1周和3个月的母婴结局进行对比分析。结果无保护会阴组产时出血量、缝合材料用量、平均住院时间均少于常规会阴切开组，差异均有统计学意义（ t＝-14．58，-97．07，-21．88；P ＜0．01）。会阴切开率无保护会阴组为24．04％（50/208），常规会阴切开组为61．26％（302/493），差异有统计学意义（χ2＝81．06，P＜0．01）；会阴状态无保护会阴组完整、仅切开、仅裂伤、切开＋裂伤例数分别为65，44，93，6人，常规会阴切开组分别为78，269，113，33人，差异有统计学意义（χ2＝81．09，P＜0．01）；会阴疼痛产后第1天、第1周、3个月，两组差异均有统计学意义（χ2＝82．95，32．51，5．58；P＜0．01）；尿潴留（χ2＝10．07，P＜0．01）、切口未愈或延迟（χ2＝18．79，P＜0．01）及性交痛（χ2＝18．83，P＜0．01）无保护会阴组明显低于常规会阴切开方法组，差异具有统计学意义。无保护会阴组第一产程（t＝-1．72，P＞0．05）、第二产程（t＝1．55，P＞0．05）、新生儿出生体质量（t＝0．91， P＞0．05）、新生儿Apgar评分＜7分（χ2＝0．10，P＞0．05）及转科（χ2＝0．60，P＞0．05）与常规会阴切开组差异均无统计学意义。结论无保护会阴分娩法能有效降低产后的短期不良影响及部分长期不良影响，是一种全新的限制性会阴切开理念。Objective To evaluate the effect of delivery without perineum protection on maternal and neonatal outcomes .Methods The current study was conducted between July 1st, 2012 and February 1st, 2013. A total of 701 maternal women were included in the study , and 208 maternal women went on unprotected perineum delivery method and 493 went into routine episiotomy .Maternal and neonatal outcomes at the first day , the first week and the third month after delivery were compared and analyzed between the two groups .Results The aspects of intrapartum hemorrhage , suture material within delivery and the average hospitalization days in unprotected perineum group were significantly lower than those in the routine episiotomy group （ t= -14.58,-97.07,-21.88, respectively;P〈0.01）.The rate of episiotomy was 24.04%（50/208） in the unprotected perineum group and 61.26% （302/493） in the routine episiotomy group, and the difference was statistically significant （χ2 =81.06,P〈0.01）.In the unprotected perineum group ,65, 44, 93 and 6 patients had perineal integrity, incision, laceration and incision with laceration , which in the routine episiotomy group were 78,269, 113 and 33, respectively, and the difference was significant （χ2 =81.09,P〈0.01）.The perineal pain at the first day,the first week and the third month after delivery were significantly different between two groups （χ2 =82.95,32.51,5.58, respectively;P〈0.01）.The incidence of postpartum urinary retention （χ2 =10.07,P〈0.01）, healing complications （χ2 =18.79,P〈0.01） at first week and painful sex （χ2 =18.83,P〈0.01） in the unprotected perineum group were significantly lower than those in the routine episiotomy group .There were no significant differences between the two groups with the aspects of time of the first （ t=-1.72,P〉0.05） and the second stage of birth （t=1.55,P〉0.05）, neonatal birth weight （t =0.91,P 〉0.05）, Apgar scores （χ2 =0.10,P〉0.05） and NICU admission （χ2 =0.60,P〉0.05）.Conclusions

关 键 词：分娩 无保护会阴分娩法 常规会阴切开分娩法 母婴结局 

分 类 号：R717[医药卫生—妇产科学]