无痛分娩中不同体位对减少产程干预的影响

The effect of different body position in labor analgesia on reduction of labor intervention

摘要:

目的 探讨无痛分娩中采取自由体位与常规卧位对减少产程干预及分娩结局的影响。方法 选择 2015 年10 月—2017 年9 月于北京中医药大学附属中西医结合医院分娩的足月、单胎、头位及初产妇160 例， 均自愿选择硬膜外自控镇痛。随机分为观察组和对照组，每组80 例。观察组麻醉后采取自由体位，第二产程胎 头拨露时采取截石位；对照组麻醉后采取常规卧位，第二产程采取截石位。对两组产妇剖宫产率、相对头盆不 称发生率、人工破膜率、催产素静脉滴注率、产后出血率、胎儿窘迫及新生儿窒息发生率进行比较，比较阴道 分娩者第一产程时间、第二产程时间，会阴裂伤、会阴侧切率的差异。结果 观察组产妇剖宫产、头盆不称、 人工破膜及催产素静脉滴注发生率低于对照组（P <0.05）。观察组产妇阴道分娩第一产程、第二产程时间及会 阴侧切率低于对照组（P <0.05）。两组产妇阴道分娩会阴裂伤率比较，差异无统计学意义（P >0.05）。其中，观 察组会阴无损伤者3 例。结论 无痛分娩中采取自由体位可降低剖宫产率、会阴侧切率，缩短产程，减少人工 破膜、催产素静脉滴注等人工干预措施，且不增加产后出血、胎儿窘迫、新生儿窒息等风险，值得临床推广。

Abstract:

Objective To study different effects of free position and normal lying position on labor intervention and delivery outcome in labor analgesia. Methods Our hospital’s 160 full term primiparas, from October 2015 to September 2017, with single pregnancy and cephalic position were randomly divided into control group and observation group with 80 patients in each. All the patients voluntarily received patient-controlled epidural analgesia (PCEA). The observation group adopted free body position after analgesia and were asked to lie in the lithotomy position when the head visible on vulval gapping at second stage of labor. The control group adopted normal lying body position after analgesia and were asked to lie in the lithotomy position at second stage of labor. Data comparison was made between the two groups in aspects like cesarean section rate, cephalopelvic disproportion (CPD), artificial rupture of membranes, oxytocin intravenous drip, postpartum hemorrhage, fetal distress and neonatal asphyxia, first stage of labor and second stage of labor in vaginal birth, perineal laceration and episiotomy. Results The cesarean section rate, cephalopelvic disproportion (CPD), artificial rupture of membranes, and oxytocin intravenous drip in the observation group were lower than those in the control group, which had statistical significance (P < 0.05). The first stage of labor, second stage of labor and episiotomy rate in the observation group were shorter than those in the control group, which had statistical significance (P < 0.05). The difference in perineal laceration had no statistical significance (P > 0.05). Among them, there were 3 cases without perineum injury in the observation group. Conclusions Free body position during labor analgesia can reduce the cesarean section and episiotomy rate, shorten stage of labor, reduce interventions like artificial rupture of membranes and oxytocin intravenous drip. At the same time, free body position does not increase the risk of postpartum hemorrhage, fetal distress and neonatal asphyxia and is worthy of overall clinic application.