家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式及结局的影响

doi:10.3760/cma.j.issn.1007-1245.2023.08.023

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (8): 1135-1140.DOI: 10.3760/cma.j.issn.1007-1245.2023.08.023

家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式及结局的影响

王宇威¹ 刘超¹ 李瑞¹ 刘晶² 张亚丽¹ 梁葵香¹

¹滨州医学院附属医院妇产科，滨州　256600；²滨州医学院附属医院超声科，滨州　256600

收稿日期:2022-10-13 出版日期:2023-04-15 发布日期:2023-05-01
通讯作者: 梁葵香，Email：byfylkx@126.com

Effects of home delivery room combined with epidural analgesia on delivery mode and outcomes of primiparae

Wang Yuwei¹, Liu Chao¹, Li Rui¹, Liu Jing², Zhang Yali¹, Liang Kuixiang¹

¹Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou 256600, China;²Department of Ultrasound , Binzhou Medical University Hospital, Binzhou 256600, China

Received:2022-10-13 Online:2023-04-15 Published:2023-05-01
Contact: Liang Kuixiang, Email: byfylkx@126.com

摘要/Abstract

摘要：

目的　探讨家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式、产程时长及母婴结局的影响。方法　收集于2019年10月至2022年2月期间，在滨州医学院附属医院具备试产条件且为单胎足月头位初产妇805例为研究对象。根据初产妇的意愿，将其分成四组：家庭化产房联合硬膜外分娩镇痛组（A组），226例，年龄21～34（27.77±2.87）岁；家庭化产房组（B组），177例，年龄17～33（27.77±3.05）岁；硬膜外分娩镇痛组（C组），198例，年龄20～36（27.21±3.15）岁；常规分娩组（D组），204例，年龄19～35（27.16±3.01）岁。通过比较各组间产妇的一般临床资料、产程时间、顺转剖宫产率、分娩出血量、分娩前后血红蛋白（Hb）差值、侧切率、产后尿潴留发生率、分娩时发热率、新生儿的各项指标情况等来研究家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式、产程及母婴结局的影响。统计学方法采用单因素方差分析、χ²检验。结果　A组［9.73%（22/226）］、C组［10.61%（21/198）］顺转剖宫产率均小于B组［33.33%（59/177）］、D组［33.33%（68/204）］，四组中A组顺转剖宫产率最低。四组经自然分娩的产妇产程比较：A组［（8.83±3.44）h］、C组［（9.56±3.98）h］总产程较B组［（6.78±2.72）h］、D组［（7.24±3.12）h］延长，四组比较，差异有统计学意义（F=21.88，P<0.05），B组较其他三组总产程、第一产程、第二产程短。C组侧切率［61.58%（109/177）］大于A组［45.10%（92/204）］、B组44.07%（52/118），四组比较，差异有统计学意义（χ²=13.12，P<0.05）；C组尿潴留率［28.28%（56/198）］大于A组［11.95%（27/226）］、B组［7.91%（14/177）］、D组［5.88%（12/204）］，差异有统计学意义（χ²=52.26，P<0.05）。产程干预分层分析同样显示，家庭化产房组较其他三组的总产程、第一产程和第二产程相对缩短；硬膜外分娩镇痛的应用使其总产程、第一产程、第二产程相对延长，但对第三产程的影响并不相同。结论　家庭化产房联合硬膜外分娩镇痛初产妇顺转剖宫产率及侧切率更低，硬膜外分娩镇痛相对延长了总产程、第一产程、第二产程时长，但其均在正常范围内，第三产程和新生儿结局无明显差异，对分娩出血量及分娩时发热率无影响，该模式是值得推广的。

关键词:

家庭化产房, 硬膜外分娩镇痛, 初产妇, 分娩方式

Abstract:

Objective　To explore the effects of family delivery room combined with epidural analgesia on the delivery mode, duration of labor, and maternal and infant outcomes of primiparae. Methods　From October 2019 to February 2022, 805 primiparae with single term cephalic presentation who met the conditions for trial delivery in Binzhou Medical University Hospital were collected as the research objects. According to their wishes, they were divided into a home-based delivery room combined with epidural delivery analgesia group (group A, 226 cases), a home-based delivery room group (group B, 177 cases), an epidural delivery analgesia group (group C, 198 cases), and a conventional delivery group (group D, 204 cases). Group A were 21-34 (27.77±2.87) years old, group B 17-33 (27.77±3.05), group C 20-36 (27.21±3.15), and group D 19-35 (27.16±3.01). By comparing the general clinical data, labor process times, rates of conversion from natural labor to cesarean section, delivery bleeding, HGB differences before and after delivery, lateral episiotomy rates, incidence rates of postpartum urinary retention, fever rates during delivery, and various indicators of the newborn, the influence of family delivery room combined with epidural analgesia on the delivery mode, delivery process, and maternal and infant outcomes was studied. One-way analysis of variance and χ² test were applied. Results　The rates of conversion from natural labor to cesarean section in group A [9.73% (22/226)] and group C [10.61% (21/198)] were lower than those in group B [33.33% (59/177)] and group D [33.33% (68/204)]; the rate of conversion from natural labor to cesarean section was the lowest in group A. The total labor processes of group A [(8.83±3.44) h] and group C [(9.56±3.98)] h were longer than those of group B [(6.78±2.72) h] and group D [(7.24±3.12) h], with a statistical difference between the 4 groups (F=21.88, P<0.05). The total labor process, the first labor process, and the second labor process of group B were the shorter than those of the other three groups. The rate of lateral resection in group C 61.58% (109/177) was significantly higher than those in group A [45.10% (92/204)] and group B [44.07% (52/118)], with a statistical difference between the four groups (χ²=13.12, P<0.05). The urinary retention rate in group C [28.28% (56/198)] was significantly higher than those in group A [11.95% (27/226)], group B [7.91% (14/177)], and group D [5.88% (12/204)], with a statistical difference between the four groups (χ²=52.26, P<0.05). Stratified analysis of labor process intervention also showed that the total labor process, the first labor process, and the second labor process of the family delivery room group were relatively shorter than those of the other three groups; the application of epidural labor analgesia could prolong the total labor process, the first labor process, and the second labor process, but had different effects on the third labor process. Conclusions　The rate of conversion from natural labor to cesarean section and the rate of lateral episiotomy of primiparae taking home delivery room and epidural labor analgesia are lower. Epidural labor analgesia relatively prolongs the total labor process, the first labor process, and the second labor process, but they are within the normal range. There is no significant difference between the third labor process and the neonatal outcomes. It has no effect on the amount of labor bleeding and the rate of fever during labor. Therefore, this mode is worthy of promotion.

Key words:

Family delivery room, Epidural analgesia, Primiparae, Delivery mode

王宇威刘超李瑞刘晶张亚丽梁葵香.

家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式及结局的影响 [J]. 国际医药卫生导报, 2023, 29(8): 1135-1140.

Wang Yuwei, Liu Chao, Li Rui, Liu Jing, Zhang Yali, Liang Kuixiang.

Effects of home delivery room combined with epidural analgesia on delivery mode and outcomes of primiparae [J]. International Medicine and Health Guidance News, 2023, 29(8): 1135-1140.

参考文献

[1] 梁晓慧.浅析剖宫产的原因及降低剖宫产率的措施[J/CD].世界最新医学信息文摘(连续型电子期刊),2015(95):302-302,308.DOI:10.3969/j.issn.1671-3141.2015.95.234.
[2] 穆光宗. 三孩政策与中国人口生育的优化:背景、前景和愿景[J].扬州大学学报(人文社会科学版),2021,25(4):65-77.DOI:10.19411/j.cnki.1007-7030.2021.04.006.
[3] 程贤鹦,孙志强.生育政策调整对剖宫产分娩的影响及三孩政策下管理策略探讨[J].中国优生与遗传杂志,2022,30(8):1296-1299.DOI:10.13404/j.cnki.cjbhh.2022.08.002.
[4] 杨晓畅,漆洪波.二孩意愿对初产妇分娩方式影响的前瞻性队列研究[J].实用妇产科杂志,2019,35(8):591-595.
[5] 孟丹丹,石静.以家庭为中心一体化产房模式对初产妇妊娠结局及产后影响[J].社区医学杂志,2020,18(13):962-965.DOI:10.19790/j.cnki.JCM.2020.13.15.
[6] 孙建玲,李翠芝,尚娟,等.家庭化产房联合无痛分娩对产后抑郁的影响以及相关因素分析[J].中国妇幼保健,2019,34(7):1519-1522.DOI:10.7620/zgfybj.j.issn.1001-4411. 2019.07.21.
[7] Lin R,Shi P,Li H,et al.Association between epidural analgesia and indications for intrapartum caesarean delivery in group 1 of the 10-group classification system at a tertiary maternity hospital, Shanghai, China: a retrospective cohort study[J].BMC Pregnancy Childbirth,2021,21(1):464.DOI:10.1186/s12884-021-03925-z.
[8] 张晶晶,何磊,王绍林.硬膜外镇痛分娩方式对初产妇妊娠结局的影响[J].蚌埠医学院学报,2021,46(8):1080-1082.DOI:10.13898/j.cnki.issn.1000-2200.2021.08.023.
[9] 阮焱,张为远.剖宫产的现状及剖宫产率高居不下的原因[J].实用妇产科杂志,2015,31(4):241-243.
[10] 刘兴会,代莉.我国自然分娩现状及展望[J].中国实用妇科与产科杂志,2015,31(2):97-100.DOI:10.7504/fk2015010101.
[11] Dickinson JE,Paech MJ,McDonald SJ,et al.The impact of intrapartum analgesia on labour and delivery outcomes in nulliparous women[J].Aust N Z J Obstet Gynaecol,2002,42(1):59-66.DOI:10.1111/j.0004-8666.2002.00065.x.
[12] Zondag DC,Gross MM,Grylka-Baeschlin S,et al.The dynamics of epidural and opioid analgesia during labour[J].Arch Gynecol Obstet,2016,294(5):967-977.DOI:10.1007/s00404-016-4110-1.
[13] 张洪星,王佃卫.不同时机实施分娩镇痛对初产妇产程和分娩方式及新生儿结局的影响[J].国际医药卫生导报,2021,27(14):2156-2159.DOI:10.3760/cma.j.issn.1007-1245. 2021.14.027.
[14] 黄淑敏,杨华.家庭化产房下的无痛分娩疗效分析[J].中国妇幼保健,2021,36(19):4437-4439.DOI:10.19829/j.zgfybj.issn.1001-4411.2021.19.015.
[15] 吴素君.一对一责任制助产护理模式对初产妇分娩方式和产程的影响研究[J].中国全科医学,2019(s1):213-216.
[16] 王恩丽.家庭化护理模式对提高初产妇自然分娩率的影响[J].浙江医学,2017,39(11):933-935.DOI:10.12056/j.issn.1006-2785.2017.39.11.2017-612.
[17] 李伟,闫福磊.以家庭为中心的产科护理模式应用于产妇分娩的效果研究[J].国际医药卫生导报,2021,27(18):2940-2943.DOI:10.3760/cma.j.issn.1007-1245. 2021.18.036.
[18] 江怡,陈银杰.初产妇阴道分娩后产后尿潴留的高危因素及低频脉冲电治疗效果[J].中国妇幼保健,2021,36(12):2732-2734.DOI:10.19829/j.zgfybj.issn.1001-4411. 2021.12.016.
[19] Anim-Somuah M,Smyth RM,Cyna AM,et al.Epidural versus non-epidural or no analgesia for pain management in labour[J].Cochrane Database Syst Rev,2018,5(5):CD000331.DOI:10.1002/14651858.CD000331.pub4.
[20] 曹莉园,周盛萍,龚云辉,等.分娩镇痛对初产妇产程的影响[J].实用妇产科杂志,2017,33(4):286-291.

家庭化产房联合硬膜外分娩镇痛对初产妇分娩方式及结局的影响

Effects of home delivery room combined with epidural analgesia on delivery mode and outcomes of primiparae

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