初产妇临产后腹压配合训练在无保护分娩中的应用研究  

Application of abdominal pressure training during "hands-off" birthing in parturient women

作　　者：李倩 许红燕[2] 黄丽玉[2] 王婕 殷叶莲 胥红斌 Li Qian;Xu Hongyan;Huang Liyu;Wang Jie;Yin Yelian;Xu Hongbin(Delivery Room, Second People′s Hospital of Changzhou,Changzhou 213000, China)

机构地区：[1]常州市第二人民医院产房,江苏常州213000 [2]常州市第二人民医院护理部,江苏常州213000 [3]常州市第二人民医院产科,江苏常州213000

出　　处：《护理学杂志》2018年第22期1-3,共3页Journal of Nursing Science

摘　　要：目的探讨腹压配合训练对初产妇第二产程腹压运用及分娩结局的影响。方法将健康初产妇随机分为观察组(n=224)和对照组(n=218)。对照组在进入第二产程后嘱其使用传统的Valsalva式用力,观察组产妇在第一产程早期开始腹压训练后嘱其跟口令用力,观察产程及分娩结局。结果观察组第二产程时间、实际使用腹压时间、产时出血量、产后1h会阴VAS评分、会阴Ⅱ度及以上裂伤率、新生儿1 min Apgar评分与对照组比较,差异有统计学意义(均P<0.01);观察组分娩体验显著优于对照组(P<0.01)。结论在无保护分娩中对临产后初产妇行腹压配合训练有助于缩短第二产程和实际用力时间,降低会阴损伤及疼痛,减少产后出血以及提高分娩的舒适感,能保障母儿安全。Objective To investigate the effect of abdominal pressure training on usage of abdominal pressure during the second stage of labor and on birth outcomes.Methods Healthy parturient women were randomly divided into an intervention group (n=224) and a control group(n=218).The control group were instructed to employ the traditional Valsalva push during the second stage of labor,while the intervention group started abdominal pressure training early in the first stage of labor and were instructed to push at the direction of midwives.The length of labor stages and birth outcomes in the 2 groups were compared.Results The length of the second stage of labor,the length of pushing with upper abdominal muscles,the volume of bleeding during birthing process,VAS pain scores at 1 h post-delivery,the incidence rate of a combined second-,third- and fourth-degree perineal tears,neonatal 1 min Apgar scores,had significant differences between the 2 groups (P<0.01 for all).The intervention group also reported better birthing experience than the controls (P<0.01).Conclusion Application of abdominal pressure training during "hands-off" birthing could shorten the length of the second stage of labor,the length of pushing with upper abdominal muscles,mitigate the risk of perineal injury and pain,reduce postpartum hemorrhage,and enhance parturient women′s comfort levels,which therefore guarantees maternal and neonatal safety.

关 键 词：初产妇 足月妊娠 无保护分娩 第二产程 腹压训练 会阴损伤 疼痛 分娩结局 

分 类 号：R473.71[医药卫生—护理学]