改良会阴评估表在限制性会阴切开难产分娩初产妇中的应用  

Modified perineum evaluation scale in restrictive episiotomy in primiparas with dystocia

作　　者：魏素花[1] 史晓红[1] 罗凤梅[1] 仇黎丽[1] 顾宁[1] WEI Su-hua;SHI Xiao-hong;LUO Feng-mei;QIU Li-li;GU Ning(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科产房,江苏南京210008

出　　处：《中国临床研究》2022年第11期1623-1627,共5页Chinese Journal of Clinical Research

基　　金：南京鼓楼医院新技术发展基金培育项目(XJSFZJJ202037);南京大学医院管理研究所课题研究项目和南京鼓楼医院医学发展医疗救助基金会资助项目(NDYG2020044)。

摘　　要：目的探讨改良会阴评估表在难产分娩初产妇限制性会阴切开中的应用效果。方法选取2019年1月至2021年12月在鼓楼医院产科经阴道难产分娩的初产妇162例,将2020年采用自制改良会阴评估量表后的60例初产妇作为观察组,2019年采用改良会阴评估量表前常规行会阴侧切下低位产钳助产的102例初产妇设为对照组。比较两组产妇产后24 h出血量、会阴裂伤程度、会阴疼痛、住院时间,以及产妇早期下床活动、尿潴留及新生儿早吮吸等情况。结果对照组Ⅱ度会阴裂伤102例,观察组最终未行会阴切开58例,Ⅰ度会阴裂伤57例,Ⅱ度会阴裂伤3例,两组会阴裂伤比较差异有统计学意义(P<0.01)。对照组产后24 h出血量[(629.33±196.97)ml vs(289.15±380.19)ml]、会阴疼痛评分[(3.65±1.45)分vs(1.91±0.88)分]、尿潴留发生率(20.59%vs 6.70%)、住院时间[(5.81±3.23)d vs(3.28±1.17)d]均高于观察组(P<0.05);早期下床活动率对照组低于观察组(80.39%vs 93.33%,P<0.05)。结论对经阴道难产分娩初产妇严格采用改良会阴评估表进行会阴评估并实施限制性会阴切开术,可改变传统难产助产常规行会阴侧切模式,减少产后出血量,有利于会阴伤口愈合,促进产妇产后恢复。Objective To investigate the application effect of modified perineum evaluation scale in primiparas with dystocia receiving restrictive episiotomy(RE)in vaginal delivery.Methods A total of 162 primiparas with dystocia at vaginal delivery were recruited from January 2019 to December 2021 in the obstetrics department of Nanjing Drum Tower Hospital.Sixty primiparas received modified perineum assessment scale in 2020 were designed as observation group,and 102 primiparas with routine perineum lateral episiotomy before low position forceps for delivery in 2019 were served as control group.The bleeding volume during 24 hours after delivery,degree of perineal laceration,perineal pain,hospital stay,maternal early ambulation activities,urine retention and newborn infant's early sucking were compared between two groups.Results There were 102 cases of degreeⅡperineal laceration in control group and 58 cases without undergoing perineum incision,57 cases of degree I perineal laceration and 3 cases of gradeⅡperineal laceration in observation group,with the statistical differences between two groups(P<0.01).The 24 h bleeding volume[(629.33±196.97)ml vs(289.15±380.19)ml],the perineal pain score(3.65±1.45 vs 1.91±0.88),the incidence of urinary retention(20.59%vs 6.70%)and the length of hospital stay[(5.81±3.23)d vs(3.28±1.17)d]in control group were significantly higher than those in observation group(P<0.05),and the number of parturient with early ambulation in control group was statistically lower than that in observation group(80.39%vs 93.33%,P<0.05).Conclusion For the primiparas with dystocia,modified perineum evaluation scale with restrictive episiotomy can effectively improve the conventional lateral incision mode,reduce the incidence of the postpartum hemorrhage and promote the healing of perineal wounds and the recovery of postpartum mothers.

关 键 词：会阴侧切术 限制性会阴切开术 会阴评估 会阴裂伤 初产妇 难产 

分 类 号：R473.71[医药卫生—护理学]