多功能可反光观察接产凳在助产士助产工作中的临床应用

夏红霞; 徐玉莹; 雷霞

doi:10.16766/j.cnki.issn.1674-4152.003295

多功能可反光观察接产凳在助产士助产工作中的临床应用

doi: 10.16766/j.cnki.issn.1674-4152.003295

1.
杭州市妇产科医院分娩中心，浙江杭州 310004
2.
杭州市第一人民医院产科，浙江杭州 310006

基金项目:

浙江省卫生健康科技计划项目 2021PY059

详细信息

通讯作者:
雷霞，E-mail：55399280@qq.com

中图分类号: R714.3 R473.71
计量
- 文章访问数: 66
- HTML全文浏览量: 15
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2023-05-25

Clinical use of a multifunctional reflective observation stool in midwifery

XIA Hongxia¹,
XU Yuying¹,
LEI Xia^{2
, ,}

1.
Department of Childbirth Center, Hangzhou Obstetrics and Gynecology Hospital, Hangzhou, Zhejiang 310004, China

摘要

摘要: 目的比较国外引进接产凳和我科多功能可反光观察接产凳进行坐式分娩在临床中的效果。方法选择2022年7—12月于杭州市第一人民医院产科分娩的130例低危初产妇为研究对象，依据使用的坐式分娩凳的不同将运用国外引进接产凳坐式分娩的65例产妇设为对照组，运用杭州市第一人民医院产科多功能可反光观察接产凳坐式分娩的65例产妇设为观察组。比较2组产妇的会阴裂伤程度、会阴侧切率、会阴水肿及会阴疼痛程度、第二产程用时、分娩后2 h出血量、分娩方式、分娩后新生儿窒息或新生儿死亡的发生情况、产妇的舒适度以及子宫复旧情况、产褥病率和产后住院时间。结果观察组产妇会阴裂伤程度、会阴侧切率明显低于对照组，同时观察组第二产程所用时间明显短于对照组[(33.43±11.26)min vs. (63.56±11.58)min]，分娩后2 h出血量少于对照组[(234.42±37.68)mL vs. (265.67±37.99)mL]，差异均有统计学意义(均P < 0.05)。观察组新生儿窒息发生率为6.15%(4/65)，明显低于对照组的18.46%(12/65)，同时观察组产妇子宫复旧情况优于对照组，产褥病发生率低于对照组且产后住院时间较对照组短，差异均有统计学意义(均P < 0.05)。结论与国外引进接产凳坐式分娩相比，运用多功能可反光观察接产凳坐式分娩具有保护会阴，减轻会阴疼痛，缩短产程和产后住院时间，促进产妇舒适分娩的优势。
- 坐式分娩 /
- 接产凳 /
- 多功能可反光 /
- 应用价值
Abstract: Objective Comparison of the clinical effectiveness of foreign-imported birthing stools and our department' s multi-functional reflective observation birthing stool for seated delivery. Methods A retrospective study was conducted on low-risk primiparous women who gave birth at Hangzhou First People' s Hospital from July to December 2022. Based on the different types of birthing stools used, a total of 65 women who underwent seated delivery with foreign-imported birthing stools were assigned to the control group, and another 65 women who underwent seated delivery with the Hangzhou First People' s Hospital multi-functional reflective observation birthing stool were assigned to the experimental group. The degree of perineal tears, episiotomy rate, perineal oedema and pain, duration of second stage of labour, postpartum bleeding within 2 hours, mode of delivery, occurrence of neonatal asphyxia or neonatal death, maternal comfort, uterine involution, puerperal morbidity rate, and length of postpartum hospital stay were compared between the two groups. Results The experimental group, using the multifunctional reflective observation birthing stool had significantly lower rates of perineal laceration and episiotomy than the control group using foreign-imported birthing stools. In addition, the duration of the second stage of labour was significantly shorter in the experimental group [(33.43±11.26) min] than in the control group [(63.56±11.58) min]; The experimental group also had less postpartum bleeding [(234.42±37.68)mL vs. (265.67±37.99)mL], and these differences were statistically significant (all P < 0.05). In addition, the incidence of neonatal asphyxia in the experimental group (6.15%, 4/65) was significantly lower than in the control group (18.46%, 12/65). The experimental group showed better uterine involution than the control group, with a lower incidence of puerperal morbidity and shorter postpartum hospital stay. These differences were statistically significant (all P < 0.05). Conclusion Compared to foreign birthing stools, the use of the multifunctional reflective observation birthing stool for seated delivery offers advantages in protecting against perineal tears and episiotomy, reducing perineal pain, shortening the duration of labour and the length of hospital stay after delivery, thus promoting maternal comfort.
- Sitting delivery /
- Delivery stool /
- Multi-functional reflective /
- Value in use
利益冲突 无

HTML全文

表 1 2组产妇一般资料比较(x±s)

Table 1. Comparison of general information between 2 groups in parturients(x±s)

组别	例数	年龄(岁)	孕周(周)	身高(cm)	体重(kg)
对照组	65	29.76±2.32	39.83±2.98	158.11±6.57	61.51±7.12
观察组	65	30.62±3.61	40.84±1.76	156.43±8.26	62.21±8.12
t值		1.616	2.353	1.283	0.523
P值		0.109	0.020	0.202	0.602

下载: 导出CSV

表 2 2组产妇会阴裂伤程度比较[例(%)]

Table 2. Comparison of perineal laceration degrees between two groups of parturients [cases(%)]

组别	例数	会阴裂伤程度					会阴侧切
组别	例数	无裂伤	Ⅰ度	Ⅱ度	Ⅲ度	Ⅳ度	会阴侧切
对照组	65	6(9.23)	27(41.54)	32(49.23)	0	0	21(32.31)
观察组	65	15(23.08)	39(60.00)	11(16.92)	0	0	9(13.85)
统计量		3.928^a					6.240^b
P值		< 0.001					0.012
注：^a为Z值，^b为χ²值。

下载: 导出CSV

表 3 2组产妇会阴水肿及会阴疼痛程度比较[例(%)]

Table 3. Comparison of perineal edema and perineal pain between two groups of parturients [cases(%)]

组别	例数	会阴水肿			会阴疼痛
组别	例数	0度	轻度	中重度	0级	Ⅰ级	Ⅱ级
对照组	65	34(52.31)	22(33.85)	9(13.85)	25(38.46)	32(49.23)	8(12.31)
观察组	65	49(75.38)	14(21.54)	2(3.08)	52(80.00)	11(16.92)	2(3.08)
Z值		2.470			4.765
P值		0.013			< 0.001

下载: 导出CSV

表 4 2组产妇第二产程用时、分娩后2 h出血量以及分娩方式的比较

Table 4. Comparing the duration of the second stage of labor, post-delivery bleeding at 2 hours, and mode of delivery between two groups of parturients

组别	例数	第二产程用时 (x±s, min)	分娩后2 h出血量 (x±s, mL)	分娩方式[例(%)]			自然分娩
组别	例数	第二产程用时 (x±s, min)	分娩后2 h出血量 (x±s, mL)	阴道顺产	阴道助产	剖宫产	自然分娩
对照组	65	63.56±11.58	265.67±37.99	30(46.15)	26(40.00)	9(13.85)	56(86.15)
观察组	65	33.43±11.26	234.42±37.68	48(73.84)	15(23.08)	2(3.08)	63(96.92)
统计量		15.039^a	4.709^a	11.560^b			4.866^b
P值		< 0.001	< 0.001	0.003			0.027
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 5 2组产妇分娩后新生儿窒息或新生儿死亡发生情况比较[例(%)]

Table 5. Comparing the degree of perineal tear between the two groups of parturients

组别	例数	新生儿窒息	新生儿死亡	合计
对照组	65	12(18.46)	1(1.54)	13(20.00)
观察组	65	4(6.15)	0	4(6.15)
χ²值		4.561		5.482
P值		0.033	0.999^a	0.019
注：^a为采用Fisher精确检验。

下载: 导出CSV

表 6 2组产妇子宫复旧情况、产褥病发生率及产后住院时间比较

Table 6. Comparing uterine involvement, incidence of puerperal disease, and postpartum hospital stay between the two groups of parturients

组别	例数	子宫复旧情况[例(%)]		产褥病 [例(%)]	产后住院时间 (x±s, d)
组别	例数	不全	良好	产褥病 [例(%)]	产后住院时间 (x±s, d)
对照组	65	15(23.08)	50(76.92)	26(40.00)	4.13±0.42
观察组	65	6(9.22)	59(90.78)	12(18.46)	2.36±0.36
统计量		4.600^a		7.288^a	25.797^b
P值		0.032		0.007	< 0.001
注：^a为χ²值，^b为t值。

下载: 导出CSV

参考文献(21)

[1]	BURROWS L J, SLOANE M, DAVIS G, et al. Parturition after vestibulectomy[J]. J Sex Med, 2011, 8(1): 303-305. doi: 10.1111/j.1743-6109.2010.01989.x
[2]	MADURO M R. Inflammatory pathways and parturition[J]. Reprod Sci, 2018, 25(2): 165. doi: 10.1177/1933719117746738
[3]	ROMANZI L J. Natural childbirth: a global perspective[J]. Virtual Mentor, 2014, 16(10): 835-841.
[4]	VERINGA-SKIBA I K, ZIEMER K, DE BRUIN E, et al. Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial[J]. BMC Pregnancy Childbirth, 2022, 22(1): 47. doi: 10.1186/s12884-022-04380-0
[5]	KIM K W, LEE S. Childbirth outcomes and perineal damage in women with natural childbirth in Korea: a retrospective chart review[J]. Korean J Women Health Nurs, 2021, 27(4): 379-387. doi: 10.4069/kjwhn.2021.08.31
[6]	DASRILSYAH R A, KALOK A, NG B K, et al. Perineal skin tear repair following vaginal birth; skin adhesive versus conventional suture: a randomised controlled trial[J]. J Obstet Gynaecol, 2021, 41(2): 242-247. doi: 10.1080/01443615.2020.1740917
[7]	HO M H, CHANG H C R, LIU M F, et al. Effectiveness of acupoint pressure on older people with constipation in nursing homes: a double-blind quasi-experimental study[J]. Contemp Nurse, 2020, 56(5-6): 417-427. doi: 10.1080/10376178.2020.1813042
[8]	郭慧芳, 陈益君, 赵婉萍, 等. 椎管内持续泵注自控分娩镇痛技术在阴道分娩产妇中的应用效果[J]. 中华全科医学, 2022, 20(10): 1711-1714. doi: 10.16766/j.cnki.issn.1674-4152.002686 GUO H F, CHEN Y J, ZHAO W P, et al. Effect of continuous intraspinal pump injection of patient-controlled labor analgesia in vaginal delivery[J]. Chinese Journal of General Practice, 2022, 20(10): 1711-1714. doi: 10.16766/j.cnki.issn.1674-4152.002686
[9]	张旱梅, 周利华, 马红, 等. 会阴切开的发生率及影响因素分析[J]. 中华全科医学, 2022, 20(9): 1517-1520. doi: 10.16766/j.cnki.issn.1674-4152.002638 ZHANG H M, ZHOU L H, MA H, et al. Incidence and influencing factors of perineotomy[J]. Chinese Journal of General Practice, 2022, 20(9): 1517-1520. doi: 10.16766/j.cnki.issn.1674-4152.002638
[10]	MCCLURG D, HARRIS F, GOODMAN K, et al. Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT[J]. Health Technol Assess, 2018, 22(58): 1-134. doi: 10.3310/hta22580
[11]	GOMES LOPES L, MAIA DUTRA BALSELLS M, TEIXEIRA MOREIRA VASCONCELOS C, et al. Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis[J]. Int J Gynaecol Obstet, 2022, 157(2): 248-254. doi: 10.1002/ijgo.13826
[12]	EAST C E, DORWARD E D, WHALE R E, et al. Local cooling for relieving pain from perineal trauma sustained during childbirth[J]. Cochrane Database Syst Rev, 2020, 10(10): CD006304. DOI: 10.1002/14651858.CD006304.
[13]	ABALOS E, SGUASSERO Y, GYTE G M. Paracetamol/acetaminophen (single administration) for perineal pain in the early postpartum period[J]. Cochrane Database Syst Rev, 2021, 1(1): CD008407. DOI: 10.1002/14651858.CD008407.
[14]	ANDRIKOPOULOU M, D' ALTON M E. Postpartum hemorrhage: early identification challenges[J]. Semin Perinatol, 2019, 43(1): 11-17. doi: 10.1053/j.semperi.2018.11.003
[15]	SOLT KIRCA A, KANZA GUL D. Effects of acupressure and shower applied in the delivery on the intensity of labor pain and postpartum comfort[J]. Eur J Obstet Gynecol Reprod Biol, 2022, 273: 98-104. doi: 10.1016/j.ejogrb.2022.04.018
[16]	BERTA M, LINDGREN H, CHRISTENSSON K, et al. Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2019, 19(1): 466-467. doi: 10.1186/s12884-019-2620-0
[17]	臧瑜, 蔡晓雪, 李兆莹, 等. 坐位分娩在第二产程应用的研究进展[J]. 医学研究与教育, 2020, 37(6): 61-66. ZNAG Y, CAI X X, LI Z Y, et al. Advances on effectiveness of the sitting position during the second stage of labour[J]. Medical Research and Education, 2020, 37(6): 61-66.
[18]	GUPTA J K, SOOD A, HOFMEYR G J, et al. Position in the second stage of labour for women without epidural anaesthesia[J]. Cochrane Database Syst Rev, 2017, 5(5): CD002006. DOI: 10.1002/14651858.CD002006.
[19]	零恒莉, 饶倩羽, 韦月婵. 第二产程自由体位分娩的研究进展[J]. 当代护士(中旬刊), 2020, 27(4): 15-17. LING H L, RAO Q Y, WEI Y C, et al. Research progress on free position delivery in the second stage of labor[J]. Today Nurse, 2020, 27(4): 15-17.
[20]	SENDEKU F W, AZEZE G G, FENTA S L. Perinatal asphyxia and its associated factors in Ethiopia: a systematic review and meta-analysis[J]. BMC Pediatr, 2020, 20(1): 135-137. doi: 10.1186/s12887-020-02039-3
[21]	周临, 梁艳, 雷霞, 等. 安全型接产凳的研制与应用[J]. 护理学报, 2021, 28(4): 77-78. ZHOU L, LIANG Y, LEI X, et al. Product quality and application of safe delivery stool[J]. Journal of Nursing, 2021, 28(4): 77-78.