基于IMB的健康指导结合自由体位在产妇分娩中的应用

doi:10.3760/cma.j.issn.1007-1245.2023.16.031

摘要/Abstract

摘要：

目的　探讨基于信息-动机-行为技巧模型（IMB）的健康指导结合自由体位分娩在产妇中的应用效果。方法　选取2020年7月至2022年7月于驻马店市中心医院生产的98例产妇进行前瞻性研究，并按照随机数字表法将其分为两组，各49例。对照组：年龄25～37（29.95±2.09）岁，初产妇34例，经产妇15例，采取常规护理。观察组：年龄25～37（29.98±2.11）岁，初产妇35例，经产妇14例，采取基于IMB的健康指导结合自由体位分娩。两组均持续护理至产妇分娩结束。评价两组健康知识掌握度、心理状态、自我效能、产程时间、分娩方式、不良母婴结局发生率和产妇满意度。统计学方法采用χ²检验、t检验。结果　护理后，观察组健康知识掌握情况中妊娠期生理变化、自然分娩优点、剖宫产适应证、影响产程的重要因素评分均高于对照组［（86.98±3.55）分比（81.15±3.46）分、（85.95±3.79）分比（82.26±3.67）分、（83.94±4.17）分比（80.08±4.11）分、（83.36±4.14）分比（80.67±4.02）分］，差异均有统计学意义（t=8.232、4.896、4.615、3.263，均P<0.05）；观察组护理后汉密尔顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）评分均低于对照组［（10.22±1.67）分比（15.53±1.89）分、（11.79±2.04）分比（16.63±2.08）分］，差异均有统计学意义（t=14.738、11.629，均P<0.05）；观察组护理后分娩自我效能量表（CBSEI-C32）总评分高于对照组［（228.87±6.56）分比（196.69±6.05）分］，差异有统计学意义（t=25.242，P<0.05）；观察组总产程时间短于对照组［（422.95±20.27）min比（500.57±25.54）min］，差异有统计学意义（t=16.664，P<0.05）；观察组转剖宫产率和阴道助产率均低于对照组［6.12%（3/49）比20.41%（10/49）、4.08%（2/49）比18.37%（9/49）］，差异均有统计学意义（χ²=4.346、5.018，均P<0.05）；不良母婴结局发生率比较，观察组低于对照组［4.08%（2/49）比20.41%（10/49）］，差异有统计学意义（χ²=6.078，P<0.05）；产妇满意度比较，观察组高于对照组［95.92%（47/49）比83.67%（41/49）］，差异有统计学意义（χ²=4.009，P<0.05）。结论　基于IMB的健康指导结合自由体位分娩能够提高产妇对健康知识掌握，有效改善其不良心理状态，促进自我效能提升，有助于顺利分娩，缩短产程时间，降低转剖宫产率和不良母婴结局发生率，产妇满意度更高。

关键词:

产妇, 信息-动机-行为技巧模型, 健康指导, 自由体位分娩, 自我效能, 转剖宫产率

Abstract:

Objective　To explore the effect applying health guidance based on information-motivation-behavior skill model (IMB) combined with free body position in parturients' delivery. Methods　A total of 98 parturients who gave birth in Zhumadian Central Hospital from July 2020 to July 2022 were selected for the prospective study. They were divided into a control group and an observation group by the random number table method, with 49 cases in each group. There were 34 primiparas and 15 multiparas in the control group; they were 25-37 (29.95±2.09) years old. There were 35 primiparas and 14 multiparas in the observation group; they were 25-37 (29.98±2.11) years old. The observation group took routine nursing, and the observation group health guidance based on IMB and free posture delivery. Both groups received continuous nursing until the end of delivery. The mastery degrees of health knowledge, psychological states, self-efficacies, labor process times, delivery modes, occurrence rates of adverse maternal and infant outcomes, and maternal satisfactions of the two groups were evaluated. χ² and t tests were applied. Results　After the nursing, the scores of the mastery of physical changes during pregnancy, natural delivery advantages, cesarean section indications, and important factors affecting the labor process in the observation group were higher than those in the control group [(86.98±3.55) vs. (81.15±3.46), (85.95±3.79) vs. (82.26±3.67), (83.94±4.17) vs. (80.08±4.11), and (83.36±4.14) vs. (80.67±4.02)], with statistical differences (t=8.232, 4.896, 4.615, and 3.263; all P<0.05). The scores of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) after the nursing in the observation group were lower than those in the control group [(10.22±1.67) vs. (15.53±1.89) and (11.79±2.04) vs. (16.63±2.08)], with statistical differences (t=14.738 and 11.629; both P<0.05). The total score of delivery self-efficacy scale (CBSEI-C32) after the nursing in the observation group was higher than that in the control group [(228.87±6.56) vs. (196.69±6.05)], with a statistical difference (t=25.242, P<0.05). The total stage of labor in the observation group was shorter than that in the control group [(422.95±20.27) min vs. (500.57±25.54) min], with a statistical difference (t=16.664, P<0.05). The conversion cesarean section rate and vaginal delivery rate in the observation group were lower than those in the control group [6.12%(3/49) vs. 20.41%(10/49) and 4.08%(2/49) vs. 18.37%(9/49)], with statistical differences (χ²=4.346 and 5.018; both P<0.05). The incidence of adverse maternal and infant outcomes in the observation group was lower than that in the control group [4.08%(2/49) vs. 20.41%(10/49)], with a statistical difference (χ²=6.078, P<0.05). The satisfaction rate of the observation group was higher than that of the control group [95.92%(47/49) vs. 83.67%(41/49)], with a statistical difference (χ²=4.009, P<0.05). Conclusion　Health guidance based on IMB combined with free body position in parturients' delivery can improve their mastery of health knowledge, unhealthy psychological state, and self-efficacy, help delivery smoothly, shorten their labor process time, and decrease the conversion cesarean section rate and incidence of adverse maternal and infant outcomes, with high satisfaction.

Key words:

Parturients, Information-motivation-behavior skill model, Health guidance, Free posture delivery, Self-efficacy, Conversion rate of cesarean section

苗喜乐胡静张俊.

基于IMB的健康指导结合自由体位在产妇分娩中的应用 [J]. 国际医药卫生导报, 2023, 29(16): 2353-2358.

Miao Xile, Hu Jing, Zhang Jun.

Application of health guidance based on IMB and free body position in delivery [J]. International Medicine and Health Guidance News, 2023, 29(16): 2353-2358.

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