阴道分娩疼痛变化趋势及其影响因素分析

Study on change trend of pain in vaginal delivery and influencing factors

摘要:

目的 了解阴道分娩产妇产程中疼痛值、疼痛部位和性质的变化趋势，为建立分娩疼痛干预模式 提供依据。方法 采用自设的问卷对222 例产妇进行调查，从产妇宫口扩张1~2 cm 开始，调查产妇整个产程 不同时点的疼痛评分、疼痛性质和部位，并追踪到分娩后1h 回顾最痛点。结果 随着宫口扩大，产妇的疼痛 值上升，直到宫口扩张7~8 cm 时达峰值，维持至宫口开全，分娩时疼痛值下降（P <0.05）。分娩期疼痛以中、 重度为主，疼痛性质在宫口扩张期以压榨性痛及痉挛性痛为主，分娩时以撕裂样痛为主。影响疼痛的主要因 素为妊娠合并症或并发症、陪伴分娩及缩宫素使用等。随着疼痛值的升高，不同程度上增加产后出血量，缩 短产程。结论 宫口开7~10 cm 是整个产程中产妇疼痛最剧烈时段，表现为压榨性疼痛，据此建议开展多中 心研究，探索适合我国国情的分娩期疼痛干预模式，如适时指导产妇体位改变、助产士陪伴等减痛干预。

Abstract:

Objective To investigate the pain value of maternal labor pain during vaginal delivery and the change trend of pain location and nature, so as to provide basis for establishment of labor pain intervention. Methods A self-designed questionnaire was used to investigate 222 cases of pregnant women. From the time of 1-2 cm dilatation of the cervix in the parturients, the pain scores and pain nature and site were investigated at different time points in the whole birth process of the parturients, and at 1 h after delivery the most painful time point was asked to review. Results With the expansion of the cervical orifice, maternal pain increased, reached the peak when the cervix was dilated to 7-8 cm, maintained till the cervical orifice was completely open, then the childbirth pain decreased (P < 0.05). In the severe pain during delivery, the nature of pain was squeezing pain and spastic pain in the period of cervical orifice expansion, and tearing pain in childbirth. Main factors affecting pain were pregnancy complications, accompanying delivery, and use of oxytocin. With the increase of pain value, the amount of postpartum hemorrhage increased to different extent, the birth process was shortened. Conclusions The opening of the cervical orifice to 7-10 cm is the most severe period of parturient pain during the whole period of labor, the maternal pain is manifested as squeezing pain. Accordingly, it is suggested that multi-center study should be carried out in order to explore the pain-relief intervention model during delivery period suitable for China's national conditions, such as the timely guidance on maternal posture change, and midwife accompany.