郑慧

[摘要]目的 分析鎮痛分娩联合自由体位分娩用于初产妇阴道分娩的价值。方法 选取2016年3月～2018年7月我院符合标准初产妇阴道分娩268例患者，根据随机数字表法分为对照组与研究组，每组各134例。对照组接受镇痛分娩，研究组在对照组基础上联合自由体位分娩，并在分娩期实施合理护理干预。比较两组产程、疼痛程度及分娩结局。结果 研究组分娩期疼痛等级为0～2级64例，对照组39例，研究组多于对照组，差异有统计学意义（Z=3.612，P<0.001）;研究组第一至第三产程及总产程分别为（6.12±1.51）h、（1.01±0.31）h、（7.88±1.59）min、（7.69±1.62）h，短于对照组的（9.01±1.79）h、（1.79±0.29）h、（12.61±2.89）min、（11.01±1.78）h，差异均有统计学意义（t=21.758、21.270、16.600、15.968，P<0.001）;研究组产后出血、中转剖宫产、新生儿窒息发生率分别为0.75%、1.49%、0.75%，低于对照组的5.97%、8.96%、5.97%，差异均有统计学意义（χ2=4.139、7.537、4.139，P<0.05）。结论 镇痛分娩联合自由体位分娩于初产妇阴道分娩效果优于单纯镇痛分娩，产妇产程缩短，分娩疼痛缓解，产后出血、新生儿窒息等不良结局发生减少，分娩安全性增加。

[关键词]初产妇;阴道分娩;镇痛分娩;自由体位分娩

[中图分类号] R714.3          [文献标识码] A          [文章编号] 1674-4721（2020）7（a）-0221-04

Effect of analgesia delivery combined with free posture delivery nursing on delivery outcome of primiparas

ZHENG Hui

Delivery Room， Shangrao Maternal and Child Health Hospital， Jiangxi Province， Shangrao   334000， China

[Abstract] Objective To analyze the value of analgesia delivery combined with free posture delivery nursing in primiparas with vaginal delivery. Methods A total of 268 primiparas with vaginal delivery who met the standard in our hospital from March 2016 to July 2018 were selected， and they were divided into control group and research group according to the random number table method， 134 cases in each group. The control group received analgesia delivery， while research group was given free posture delivery based on control group， and was given reasonable nursing intervention during delivery. The time of each stage of labor， pain degree and delivery outcome were compared between the two groups. Results There were 64 cases of pain degree with 0-2 during delivery in research group and 39 cases in control group， and research group was more than control group， and the difference was statistically significant （Z=3.612， P<0.001）. The time of first to third stage of labor and total stages of labor in research group （[6.12±1.51] h， [1.01±0.31] h， [7.88±1.59] min， [7.69±1.62] h） were shorter than those in control group （[9.01±1.79] h， [1.79±0.29] h， [12.61±2.89] min， [11.01±1.78] h）， and the differences were statistically significant （t=21.758， 21.270， 16.600， 15.968， P<0.001）. The incidence of postpartum hemorrhage rate， conversion to cesarean section and neonatal asphyxia in research group （0.75%， 1.49%， 0.75%） were lower than those in control group （5.97%， 8.96%， 5.97%）， and the differences were statistically significant （χ2=4.139， 7.537， 4.139， P<0.05）. Conclusion Analgesia delivery combined with free posture delivery for primiparas with vaginal delivery is better than simple analgesia delivery， it can shorten the time of stages of labor， relieve delivery pain， reduce the incidence of postpartum hemorrhage and neonatal asphyxia， and increase the safety of delivery.

[Key words] Primiparas; Vaginal delivery; Analgesia delivery; Free posture delivery

分娩疼痛是产妇均要面对的自然生理现象，因害怕疼痛感过于剧烈无法承受，多数产妇主动要求经镇痛分娩辅助分娩[1]。镇痛分娩是一种麻醉减痛辅助分娩方式，该技术虽能缓解产痛，但并不是完全无痛的，甚至对某些产妇而言，在给予药物镇痛分娩后仍能感受到剧烈疼痛，此时还要为产妇联合其他干预手段，以减轻产痛[2]。近几年，国内外学者一直对分娩各阶段进行研究，以找到能促进阴道分娩的有利因素。研究发现，分娩体位的合理选择对分娩结局有较大影响[3]。既往的研究认为截石位是最安全有效的分娩体位，但随着研究深入，发现存在较多弊端[4]。自由体位分娩，即产妇不需要一直维持某种特定体位，可自主选择术式的体位分娩，该分娩体位的应用不仅能加快产程进展，促进自然分娩，还能有效减少分娩期相关并发症的发生[5]。……