低风险初产妇入产房时机对分娩结局及产程的影响  

Effects of admission time to delivery room on delivery outcome and labor duration in low-risk primiparous women

作　　者：李翰玲 马建娣[2] 陈贵君 Li Hanling;Ma Jiandi;Chen Guijun(Nursing College,Zhejiang Chinese Medical University,Hangzhou 310000,China)

机构地区：[1]浙江中医药大学护理学院,浙江杭州310000 [2]浙江省人民医院产科

出　　处：《护理学杂志》2023年第21期1-5,共5页Journal of Nursing Science

摘　　要：目的探讨基于“新产程标准及处理的专家共识”的低风险初产妇选择送入产房的时机对分娩结局和产程的影响。方法将401例产妇纳入回顾性队列研究。根据临产后送入产房时宫口扩张情况分为宫口扩张<3 cm为A组(n=207),3~<6 cm为B组(n=132),≥6 cm为C组(n=62)。比较三组产妇的临床基本情况、分娩结局及三组阴道分娩产妇的产程时长。采用logistic多因素回归分析不同时机入产房对分娩结局的影响;运用Kaplan-Meier法绘制三组产妇的产程时长曲线图,采用Cox多因素回归分析产妇在不同时机进入产房对产程时长的影响。结果新生儿出生体质量,产妇剖宫产率、产程中缩宫素使用率、无痛分娩率三组间存在统计学差异(均P<0.05)。多因素logistic回归分析结果显示,B、C组剖宫产率、缩宫素使用率、无痛分娩率显著低于A组(均P<0.05)。三组阴道分娩产妇第一产程时长、总产程时长差异有统计学意义(均P<0.05),两两比较A组>B组>C组(均P<0.05)。Kaplan-Meier曲线显示:产妇入产房的不同时机对第一产程时长和总产程时长有影响(均P<0.05);以A组作为参照,多因素Cox回归分析显示:第一产程时长B组的HR(95%CI)为1.527(1.191,1.958),P<0.05;C组的HR(95%CI)为5.230(3.711,7.370),P<0.05;总产程时长B组的HR(95%CI)为1.410(1.102,1.804),P<0.05;C组的HR(95%CI)为4.367(3.118,6.118),P<0.05。结论低风险初产妇基于“新产程标准及处理的专家共识”选择宫口扩张≥6 cm进入产房,可以减少不必要的产科医疗干预,缩短产程,降低无痛分娩率、缩宫素使用率及剖宫产率。Objective To explore the effects of admission time to delivery room based on the expert consensus on new labor standards and treatment on delivery outcome and labor duration in low-risk primiparous women.Methods A total of 401 primiparous women were enrolled in the retrospective cohort study,who were then divided into three groups according to the dilatation of the cervix at the admission time to the delivery room after labor:those with the dilatation of the cervix<3 cm was group A(n=207),those with 3 cm or more but less than 6 cm was group B(n=132),and the left with 6 cm or more was group C(n=62).The clinical basic conditions,delivery outcomes and the labor duration among the three groups were compared.The logistic multivariate regression analysis was conducted to analyze the effect of different admission time to the delivery room on the delivery outcomes.Then the Kaplan-Meier method was used to draw the labor duration curve of the three groups,and Cox multivariate regression analysis was conducted to analyze the effect of different admission time to the delivery room on labor duration.Results There were significant differences in neonatal birth weight,Cesarean section rate,the use rate of oxytocin during labor,and the rate of painless de-livery among the three groups(all P<0.05).The logistic multivariate regression analysis indicated that,the rates of Cesarean section,use of oxytocin during labor and painless delivery in group B and C were significantly lower than those in group A as a control(all P<0.05).There were significant differences in the first-stage labor duration and the total duration of labor among the three groups(both P<0.05),and when compared between each two groups,group A>group B>group C(all P<0.05).The Kaplan-Meier curve showed that,the different admission time to the delivery room had effects on the first-stage labor duration and the total duration of labor(all P<0.05),when taking group A as a control,the multivariate Cox regression analysis indicated that,the HR(95%CI)of the first-stage labo

关 键 词：初产妇 新产程标准及处理的专家共识 宫口扩张 产房 产程 无痛分娩 缩宫素 分娩结局 

分 类 号：R473.71[医药卫生—护理学]