第二产程高半卧位体位分娩在硬膜外分娩镇痛中的应用研究  

Application of High Semi-decubitus Position in Epidural Labor Analgesia in the Second Stage of Labor

作　　者：何丽蓉 徐萌艳 蔡锋成 HE Lirong;XU Mengyan;CAI Fengcheng(Department of Obstetrics and Gynecology,Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou Zhejiang 310007,China;Delivery Center,Hangzhou Women′s Hospital,Hangzhou Zhejiang 310008,China)

机构地区：[1]浙江中医药大学附属杭州市中医院妇产科,浙江杭州310007 [2]杭州市妇产科医院分娩中心,浙江杭州310008

出　　处：《实用妇产科杂志》2024年第2期141-145,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨第二产程高半卧位体位在硬膜外镇痛分娩初产妇中应用的有效性及安全性。方法:采用随机数字表法将2021年5月1日至7月30日在杭州市妇产科医院分娩的120例孕妇随机性的分为研究组(n=60)和对照组(n=60)。对照组第二产程采用仰卧位体位用力,研究组在第二产程采用仰卧位体位用力30分钟,未见胎头拨露时改为高半卧位体位用力。比较不同分娩体位对硬膜外镇痛分娩初产妇的第二产程时长、分娩方式、产后出血量、会阴损伤情况、分娩用力经验感受及分娩控制感的影响,比较新生儿窒息的情况。结果:研究组宫口开全至胎头拨露时长、宫口开全至胎头着冠时长、第二产程时长均短于对照组;自然分娩率高于对照组;会阴切开率和会阴Ⅱ级裂伤率低于对照组;产时+产后2小时出血量少于对照组;分娩体验感及分娩控制感分数高于对照组,差异均有统计学意义(P<0.05)。新生儿1分钟Agpar评分与5分钟Agpar评分在两组比较差异无统计学意义(P>0.05)。结论:硬膜外分娩镇痛下高半卧位体位的应用可以促进阴道自然分娩,缩短第二产程时间,减少会阴损伤情况,减少产后出血量,有较正向的分娩用力经验感受,可以增加分娩控制感。Objective:To investigate the efficacy and safety of high semi-decubitus position in the second stage of labor in epidural analgesic delivery of primipara.Methods:A total of 120 women who gave birth in Hangzhou women′s Hospital from May 1,2021 to July 30,2021 were randomly divided into experimental group(n=60)and control group(n=60)by random number table method.The control group adopted supine position in the second stage of labor,and the experimental group transferred to high semi-supine position after the supine position was used applied for 30 minutes when the fetal head was not exposed.To compare the effects of different postural positions on the duration of the second stage of labor,mode of delivery,postpartum injury,perineal tearing,labor force experience and labor control,and neonatal asphyxia.Results:The duration of uterine opening to fetal head exposure,the duration of uterine opening to fetal head crown and the duration of second stage of labor in experimental group were shorter than those in control group.The rate of natural delivery of experimental group was higher than that of control group.The episiotomy rate and the second degree perineal laceration rate were lower than that of control group.The amount of blood loss during delivery and 2h postpartum of experimental group was less than that of control group.The scores of birth experience and birth control of experimental group were higher than those of control group,and the differences were statistically significant(P<0.05).There was no significant difference in 1-minute Agpar score and 5-minute Agpar score between the two groups(P>0.05).Conclusions:The application of high semi-decubitus position under epidural labor analgesia promoted vaginal natural labor,shortened the time of second stage of labor,reduced episiotomy rate and perineal laceration degree,reduced postpartum hemorrhage,had positive labor force experience,and increased the sense of labor control.

关 键 词：硬膜外镇痛 体位 分娩 第二产程 分娩控制感 

分 类 号：R717[医药卫生—妇产科学]