本文關(guān)鍵詞： 限制會(huì)陰切開 自然分娩 單胎 頭位 足月 初產(chǎn)婦　出處：《蘭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 研究在單胎頭位足月初產(chǎn)的自然分娩中(正常體重兒和巨大兒)實(shí)施限制會(huì)陰切開(Restrictive Episiotomy, RE)對(duì)會(huì)陰裂傷率及切開率、新生兒窒息率、第二產(chǎn)程時(shí)間、產(chǎn)后2h失血量、42天盆底肌力以及會(huì)陰切開和自然裂傷對(duì)產(chǎn)婦在下床活動(dòng)時(shí)間、會(huì)陰傷口疼痛、傷口腫脹及滿意度方面的影響。 方法 第一部分選取2012.5-2012.7在甘肅省婦幼保健院自然分娩的初產(chǎn)婦543例及其新生兒作為觀察組,采取兩側(cè)陰部神經(jīng)阻滯麻醉、維生素AD滴劑潤(rùn)滑陰道和改進(jìn)接產(chǎn)手法等方法實(shí)施RE。以2010.1-2010.4在甘肅省婦幼保健院自然分娩的初產(chǎn)婦500例及其新生兒為對(duì)照組,采用傳統(tǒng)的接生方法,不限制會(huì)陰切開,將兩組作回顧性病例對(duì)照分析。 兩組孕婦年齡相當(dāng),觀察組年齡26.78±3.73歲,對(duì)照組26.76±3.71歲；觀察組身高162.59±3.09cm,對(duì)照組162.25±2.91cm；新生兒體重2500-4000g,觀察組3363.34±290.29g,對(duì)照組為3377.97±250.07g；兩組間孕婦年齡、身高和新生兒體重均沒有差異(P0.05)。納入標(biāo)準(zhǔn)：?jiǎn)翁ヮ^位、足月、自然分娩的初產(chǎn)婦及其新生兒；無(wú)較嚴(yán)重妊娠合并癥、內(nèi)外科并發(fā)癥；無(wú)軟硬產(chǎn)道的異常如會(huì)陰處有明顯瘢痕、較重的外陰炎癥、恥骨弓低等。 比較兩組會(huì)陰裂傷率和切開率、新生兒窒息率(1分鐘Apgar評(píng)分4-7分為輕度窒息,0-3分為重度窒息)、第二產(chǎn)程時(shí)間、產(chǎn)時(shí)產(chǎn)后2小時(shí)失血量(采用容積法和稱重法)、采用陰道肌力表測(cè)定42天盆底肌力。 第二部分為觀察RE用于巨大兒分娩的可行性和安全性,分別選取2010.1-2010.12和2012.1-2012.12自然分娩巨大兒(體重≥4000g)的初產(chǎn)婦及其新生兒74例和84例,分別作為對(duì)照組和觀察組,對(duì)照分析產(chǎn)婦的會(huì)陰結(jié)局(會(huì)陰切開和會(huì)陰裂傷)、新生兒窒息率以及新生兒產(chǎn)傷(臂叢神經(jīng)損傷、鎖骨骨折等)發(fā)生率。兩組孕婦年齡相當(dāng),對(duì)照組26.80±3.57歲,觀察組26.04+3.90歲；對(duì)照組為163.12±2.65cm,觀察組身高為163.88±2.95cm；新生兒體重4000-4200g,對(duì)照組4057.02±42.29g,觀察組4056.90±46.39g；兩組間孕婦的年齡、身高以及新生兒體重沒有差異(P0.05)。納入標(biāo)準(zhǔn)：?jiǎn)翁ヮ^位、足月、自然分娩的初產(chǎn)婦及其新生兒；無(wú)較嚴(yán)重妊娠合并癥、內(nèi)外科并發(fā)癥；無(wú)軟硬產(chǎn)道的異常如會(huì)陰處有明顯瘢痕、較重的外陰炎癥、恥骨弓低等。 第三部分收集2013.10～2013.12自然分娩的單胎頭位初產(chǎn)婦600例,行會(huì)陰切開者192例(切開組),自然裂傷者408例(裂傷組),分別填寫自制產(chǎn)婦調(diào)查表,觀察兩組下床活動(dòng)時(shí)間、產(chǎn)后傷口疼痛及腫脹和患者滿意度。 在這一時(shí)期內(nèi)我院分娩中心主要助產(chǎn)人員構(gòu)成無(wú)明顯變化。 結(jié)果 1、正常體重兒觀察組和對(duì)照組的會(huì)陰切開率、會(huì)陰完整率及Ⅰ°、Ⅱ°裂傷率分別為20.26%和71.20%(P0.05)、16.57%和4.40%(P0.05)、55.80%和20.00%(P0.05)、7.18%和4.20%(P0.05),會(huì)陰Ⅲ°裂傷率分別為0.18%和0.20%(P0.05),兩組均未發(fā)生會(huì)陰Ⅳ°裂傷； 2、正常體重兒觀察組和對(duì)照組的新生兒輕度窒息率分別為2.21%和2.20%(P0.05),且均未發(fā)生新生兒重度窒息； 3、正常體重兒觀察組和對(duì)照組的第二產(chǎn)程時(shí)間分別為219.39±106.61min和223.18±113.41min (P0.05),產(chǎn)后2小時(shí)失血量分別為44.13+22.69ml和42.66+19.27ml(P0.05)： 4、正常體重兒觀察組和對(duì)照組盆底肌力測(cè)定一類肌纖維0-3級(jí)者為88.06%和83.02%(P0.05),二類肌纖維0-3級(jí)者為85.07%和81.60%(P0.05)； 5、實(shí)施限制會(huì)陰切開分娩巨大兒的產(chǎn)婦(觀察組)會(huì)陰切開率為53.57%,明顯低于對(duì)照組的86.48%(P0.05),兩組新生兒輕度窒息率分別為3.57%和2.70%(P0.05),均未發(fā)生新生兒重度窒息和新生兒產(chǎn)傷； 6、裂傷組和切開組的產(chǎn)婦滿意度在90%及以上者分別為93.48%和77.08%(P0.05),下床活動(dòng)時(shí)間4h者分別為79.13%和36.46%(P0.05),會(huì)陰傷口疼痛及傷口腫脹程度兩組有差異(P0.05)。 結(jié)論 1、RE的實(shí)施,對(duì)第二產(chǎn)程、新生兒窒息率、產(chǎn)后2h失血量、42天盆底肌力等指標(biāo)無(wú)明顯不良影響,且并未增加會(huì)陰嚴(yán)重裂傷率,說明其是相對(duì)安全的； 2、RE使會(huì)陰切開率下降明顯,相應(yīng)提高了產(chǎn)婦的滿意度,而且可使產(chǎn)婦早下床活動(dòng),會(huì)陰傷口疼痛和傷口腫脹明顯減輕。
[Abstract]:Purpose The effects of limiting episiotomy ( RE ) on the rate and incision rate , neonatal asphyxia rate , second labor time , 2 h blood loss , 42 days pelvic floor muscle strength and episiotomy and natural cleavage were studied in the spontaneous delivery ( normal weight infants and huge infants ) born in the early part of the single fetal head . method In the first part , 543 patients and their newborns were selected in the maternal and child health care hospital in Gansu Province . The age , height and body weight of the pregnant women in the two groups were 162.59 鹵 3.09cm , 162.25 鹵 2.91 cm in the control group , 3363.34 鹵 298.29g in the control group and 3377.97 鹵 250.07 g in the control group . The rate of rupture and incision rate of the two groups were compared , the neonatal asphyxia rate ( 1 minute ' s score 4 - 7 was divided into mild asphyxia , 0 - 3 was divided into severe asphyxia ) , the second labor time was 2 hours after the birth , the blood loss was 2 hours postpartum ( using the volume method and the weighing method ) , and the pelvic floor muscle strength was measured by using the vaginal muscle strength meter . In the second part , we observed the feasibility and safety of RE for large infant delivery . In the control group and observation group , there were 74 cases and 84 cases of pregnant women with large infant ( 鈮，

本文編號(hào)：1453000