初产妇第二产程直立位分娩对分娩结局的影响  

Influence of the upright position delivery in the second stage of labour on delivery outcomes in primiparas

作　　者：魏涛[1] 谢雨斐 王德慧[1] Wei Tao;Xie Yufei;Wang Dehui(Department of Obstetrics,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,P.R.China,Beijing 100730,China;School of Nursing,Peking Union Medical College,Beijing 100144,China)

机构地区：[1]北京医院产科国家老年医学中心中国医学科学院老年医学研究院,北京100730 [2]北京协和医学院护理学院,北京100144

出　　处：《中国实用护理杂志》2023年第16期1212-1216,共5页Chinese Journal of Practical Nursing

基　　金：中央高水平医院临床科研业务费资助(BJ-2021-222)。

摘　　要：目的探讨初产妇在第二产程采用直立位分娩对分娩结局的影响,为形成系统化的分娩管理策略提供参考。方法本研究为队列研究,选择2022年1—12月在北京医院产科住院分娩的初产妇共454例,在第二产程,根据初产妇意愿分为直立位组(222例)和平卧位组(232例),直立位组和平卧位组分别采用直立位或平卧位方式进行分娩,观察并比较2组初产妇第二产程时长和会阴损伤、阴道助产、新生儿窒息发生情况以及药物镇痛对分娩结局的影响。结果直立位组初产妇的第二产程时长为30(22,50)min,短于平卧位组的48(30,80)min,差异有统计学意义(Z=-5.90,P<0.05);直立位组初产妇的会阴侧切率为17.6%(39/222),低于平卧位组的28.0%(65/232),差异有统计学意义(χ^(2)=7.02,P<0.05);2组初产妇会阴Ⅱ度损伤发生率、阴道助产率、肩难产率、新生儿窒息发生率比较差异无统计学意义(P>0.05)。直立位组药物镇痛与非药物镇痛初产妇阴道助产发生率分别为10.9%(14/129)、2.2%(2/93),差异有统计学意义(Fisher确切概率法,P<0.05),平卧位组药物镇痛与非药物镇痛初产妇第二产程时长分别为53(32,85)、41(27,59)min,差异有统计学意义(Z=-3.28,P<0.05)。结论初产妇在第二产程采用直立位分娩,能够缩短第二产程时长,降低会阴侧切率,优化分娩结局,对于药物镇痛初产妇条件允许的情况下建议采取直立位分娩。Objective To investigate the influence of the upright position delivery in the second stage of labour on delivery outcomes in primiparas,so as to provide reference for the formation of systematic delivery management strategies.Methods This study was a cohort study,454 primiparas who delivered in Beijing Hospital from January 2022 to December 2022 were selected.In the second stage of labour,according to the willingness of the primiparas,they were divided into the upright group(delivered in upright position,222 cases)and the supine group(delivered in supine position,232 cases).The duration of the second stage of labour,perineal injury,vaginal midwifery,neonatal asphyxia,and the effect of pharmacological analgesia on delivery outcomes in two groups of primiparas were observed and compared.Results The duration of the second stage of labour was 30(22,50)min in the upright group,which was shorter than 48(30,80)min in the supine group,with statistically significant difference(Z=-5.90,P<0.05).The rate of lateral episiotomy was 17.6%(39/222)in the upright group,which was lower than 28.0%(65/232)in the supine group,with statistically significant difference(χ2=7.02,P<0.05).There was no significant difference in the incidence of second degree perineal injury,vaginal midwifery,shoulder difficulty rate and neonatal asphyxia in the two groups(P>0.05).The incidence of vaginal midwifery was 10.9%(14/129)and 2.2%(2/93)respectively in the upright group with pharmacological analgesia and non pharmacological analgesia,and the difference was statistically significant(Fisher's exact test,P<0.05).The duration of the second stage of labour was 53(32,85),41(27,59)min in the supine group with pharmacological analgesia and non pharmacological analgesia,and the difference was statistically significant(Z=-3.28,P<0.05).Conclusions The adoption of upright position in the second stage of labour for primiparas can shorten the duration of the second stage,and reduce the rate of lateral episiotomy which can optimize the delivery outcome.For primip

关 键 词：第二产程 初产妇 直立位 药物镇痛 

分 类 号：R714.3[医药卫生—妇产科学]