以会阴中心腱紧张度控制胎头娩出速度对会阴损伤和产程的影响  

Effect of controlling fetal head delivery speed according to perineal central tendon tension on perineal injury and duration of delivery

作　　者：孙立琴[1] 樊雪梅 李六兰 章明 周春秀[1] Sun Liqin;Fan Xuemei;Li Liulan;Zhang Ming;Zhou Chunxiu(Delivery Room,Women′s Hospital of Nanjing Medical University,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院产房,江苏南京210004

出　　处：《护理学杂志》2023年第16期27-29,58,共4页Journal of Nursing Science

基　　金：江苏省妇幼保健课题项目(FYX202014);南京市卫生科技发展专项资金项目(YKK21162);国家自然科学基金青年项目(72204123)。

摘　　要：目的以会阴中心腱紧张度为标准控制胎头娩出速度,以减轻会阴损伤及缩短产程。方法将520例经阴道分娩的初产妇按照住院时间分为观察组和对照组各260例。观察组以会阴中心腱紧张度为标准控制胎头娩出速度,对照组依据每次用力时胎头露出阴道外口直径<1 cm为标准控制胎头娩出速度。结果两组均未发生会阴Ⅲ、Ⅳ度裂伤,观察组会阴裂伤或会阴切开、会阴切开伴裂伤率显著低于对照组,且观察组胎头拨露至胎头娩出时间、第二产程时间显著短于对照组(均P<0.05)。结论在无保护或适度保护会阴接产中以会阴中心腱紧张度为标准控制胎头娩出速度,有利于减轻分娩期会阴损伤程度,促进胎儿娩出。Objective To control the delivery speed of fetal head according to the tension of perineal central tendon,so as to reduce perineal injury and shorten the duration of vaginal-delivery.Methods A total of 520 primiparas who delivered vaginally were divided into an intervention group and a control group chronologically,with 260 cases in each group.In the intervention group,the perineal central tendon tension was used as a standard to control the delivery speed of the fetal head,while the control group relied on the diameter(<1 cm)of the fetal head exposing the external vaginal openning when it was pushed each time.Results There was no degree Ⅲ or Ⅳ perineal laceration in either of the two groups.The rates of perineal laceration or perineotomy,perineotomy with laceration in the intervention group were significantly lower than those in the control group,and the time from fetal head exposing to actual delivery,as well as the duration of second stage of labor in the intervention group were significantly shorter than those in the control group(all P<0.05).Conclusion In unprotected or moderately protected perineal delivery,controlling the delivery rate of the fetal head according to perineal central tendon tension,is conducive to reducing the degree of perineal injury during delivery and improving fetal delivery.

关 键 词：初产妇 阴道分娩 无保护会阴接产 会阴中心腱紧张度 会阴损伤 产程 

分 类 号：R473.71[医药卫生—护理学]