米丽邦古丽·吾布里 马瑛 丁桂凤

[摘要] 目的 探讨自由体位分娩联合自然娩肩法对妊娠结局和产妇产后恢复的影响。 方法 选择2015年7月～2017年7月新疆乌鲁木齐市妇幼保健院收治的产妇68例，按照随机数字表法将产妇分为对照组和观察组，各34例。对照组产妇采用传统体位分娩联合传统娩肩法进行分娩，观察组产妇采用自由体位分娩联合自然娩肩法进行分娩。分娩结束后，对两组产妇的妊娠结局、产程时间、产妇产后恢复和生殖道损伤情况进行统计分析。 结果 与对照组比较，观察组产妇的剖宫产率，新生儿窒息、锁骨骨折和肩难产发生率，产后2 h出血量和产痛均较低，分娩控制感较高；产妇第一产程、第二产程、第三产程和总产程时间均较短，产后泌乳量均明显升高，子宫高度、恶露排出量和焦虑程度显著下降，产后尿潴留和会阴Ⅲ度裂伤发生率明显较低；差异均有统计学意义（P < 0.05）。 结论 自由体位分娩联合自然娩肩法能够有效改善妊娠结局，有利于产妇产后恢复，能够缩短产程，降低生殖道损伤程度，值得在临床上推广应用。

[关键词] 自由体位分娩；自然娩肩法；妊娠结局；产后恢复

[中图分类号] R714.3 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0066-05

[Abstract] Objective To explore the influence of free position delivery combined with natural shoulder delivery method on pregnancy outcome and puerpera postpartum recovery. Methods From July 2015 to July 2017， 68 cases of puerpera admitted in Urumqi Maternity and Child Healthcare Hospital were divided into control group and observation group by random table method， with 34 cases in each group. The control group was delivered by traditional position delivery combined with traditional shoulder delivery method， while the observation group was treated with free position delivery combined with natural shoulder delivery method. After the childbirth， the pregnancy outcomes， labor duration， postpartum recovery and reproductive tract injuries after childbirth were statistically analyzed. Results Compared with the control group， the cesarean section rate， neonatal asphyxia， clavicular fracture and the incidence of shoulder dystocia， 2 h postpartum blood loss and labor pain in the observation group were significantly lower， the control sense of delivery was significantly higher； the first， second， third and total stage of delivery time in observation group were significantly lower， the lactation volume was higher， the uterine height， lochia discharge and anxiety were lower， the maternal postpartum urinary retention and perineal laceration Ⅲ degree was significantly lower in observation group； the differences were statistically significant （P < 0.05）. Conclusion Free position delivery combined with natural shoulder delivery method can effectively improve the pregnancy outcome， facilitate postpartum recovery， shorten the delivery process and reduce the degree of genital tract injury， which is worthy of clinical application.

[Key words] Free position delivery； Natural shoulder delivery method； Pregnancy outcome； Postpartum recovery

妊娠屬于女性特殊时期，分娩是每个产妇都要经历的过程，产妇在此时期承受生理及心理的双重影响，同时产妇的适应能力也会受到分娩过程的影响[1-2]。近年来，剖宫产率日益升高，虽然剖宫产能够有效缓解分娩过程中的疼痛，但是存在局限性，产生的并发症可造成极大影响，故而机体处于正常状态下，临床医师多提倡自然分娩，并寻求有效的措施降低剖宫产率[3-4]。自然分娩对母体的损伤小，出血量少，并且利于产后恢复，但是自然分娩也可能对新生儿和母体造成损伤，因此选择最优的分娩方式在临床上具有重要意义[5]。……