初产妇无痛分娩第二产程中自由体位与传统体位对妊娠结局的影响

摘要

[目的]探讨初产妇无痛分娩第二产程中自由体位与传统体位对妊娠结局的影响.[方法]120例初产妇随机分为自由组和传统组各60例.两组均采用无痛分娩椎管内麻醉,待进入第二产程后,传统组采用传统卧位待产,自由组采用自由体位待产.比较两组产程、妊娠结局、并发症发生情况及产后主观分娩疼痛程度、分娩控制感.[结果]自由组初产妇第二产程时间、胎心异常好转时间明显短于传统组(P<0.05),且第二产程中胎心率异常发生率明显低于传统组;自由组初产妇自然分娩率明显高于传统组,中转剖宫产率明显低于传统组(P<0.05);与传统组相比,自由组初产妇会阴侧切率显著降低,产后不适、张力性尿失禁发生率及新生儿窒息发生率明显减少(P<0.05);且自由组初产妇主观分娩视觉模拟疼痛(VAS)评分明显低于传统组,分娩控制量表(LAS)评分明显高于传统组(P<0.05).[结论]与传统体位相比,初产妇无痛分娩第二产程中采用自由体位待产可明显缩短产程时间,提高自然分娩率,减少母婴并发症,并可进一步减轻分娩疼痛和提高分娩控制感,值得临床推广应用.%[Objective]ToinvestigatetheeffectoffreepostureandtraditionaLpositionofprimiparaduringthe secondstageofpainLessLaboronpregnancyoutcomes.[Methods]AtotaLof120primiparaswererandomLydivided intothefreegroupandthetraditionaLgroup,with60casesineachgroup.TheprenataLinterventionofthetwo groupswasthesame,andtheyweregivenspinaLanesthesiaofpainLessLabor.Whenenteringthesecondstageof Labor,thetraditionaLgroupadoptedthetraditionaLsupinebeforedeLiverywhiLethefreegroupadoptedfreeposi-tion.ComparisonsweremadebetweenthetwogroupsintermsofLaborprocess,pregnancyoutcome,compLica-tions,postpartumsubjectivepainandsenseofdeLiverycontroL.[ResuLts]ThesecondstageofLaborinthefree groupwassignificantLyshorterthanthatinthetraditionaLgroup (P<0.05),andtheincidenceofabnormaLfetaL heartrateinthesecondstageofLaborwassignificantLyLowerthanthatinthetraditionaLgroup.Theimprovement timeofabnormaLfetaLheartratewassignificantLyshorterthanthatinthetraditionaLgroup(P<0.05).Thenatu-raLdeLiveryrateofprimiparainthefreegroupwassignificantLyhigherthanthatinthetraditionaLgroup,andthe transitcesareansectionratewassignificantLyLowerthanthatinthetraditionaLgroup(P<0.05).Comparedtothe traditionaLgroup,theincidencesofLateraLperineaLexcision,postpartumdiscomfort,tensionurinaryincontinence andneonataLasphyxia weresignificantLyLowerinthefreegroup (P <0.05).ThepainvisuaLanaLoguescaLe (VAS)scoreofsubjectivedeLiveryinthefreegroupwassignificantLyLowerthanthatinthetraditionaLgroup,and theparturitioncontroL(LAS)scorewassignificantLyhigherthanthatinthetraditionaLgroup (P<0.05).[Con-cLusion]ComparedtothetraditionaLposition,thefreepostureduringthesecondstageofprimiparapainLessLabor canshortentheLabortime,improvetherateofnaturaLdeLiveryandreducematernaLandneonataLcompLications. Thus,itcanfurtherreduceLaborpainandimproveparturitioncontroL.