中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2011年
10期
753-757
,共5页
分娩疼痛%恐惧%紧张症%应激,心理学%催眠药和镇静药%预后
分娩疼痛%恐懼%緊張癥%應激,心理學%催眠藥和鎮靜藥%預後
분면동통%공구%긴장증%응격,심이학%최면약화진정약%예후
Labor pain%Fear%Catatonia%Stress,psychological%Hypnotics and sedatives%Prognosis
目的 评估分娩疼痛程度及其相关因素与分娩结局.方法 选择2009年7-12月在浙江中医药大学附属第二医院住院分娩的正常单胎头位产妇111例,其中高龄产妇5例,采用视觉模拟评分( VAS)法评估潜伏期、活跃期疼痛程度；评估疼痛相关因素包括孕妇年龄、孕次、产次、职业、文化程度、居住地等.自行设计调查问卷,由经过培训的专业人员分别对孕妇进行分娩认知、分娩的心理准备、情绪控制能力、夫妻感情、婆媳关系、与父母关系、家庭经济状况的评估,记录产程中镇静剂的应用情况,统计分娩结局.结果 (1)疼痛相关因素:潜伏期:高龄产妇中度疼痛发生率(1/5)明显低于适龄产妇(76.4％,81/106)；对分娩认知良好的产妇中度疼痛发生率(64.7％,44/68)低于认知不足的产妇(88.4％,38/43)；夫妻感情良好的产妇中度疼痛发生率(77.2％,78/101)明显高于感情一般的产妇(4/10);经产妇中度疼痛发生率明显低于初产妇,上述各项比较,差异均有统计学意义(P＜0.05).活跃期:进入活跃期的产妇共106例,其中对分娩的心理准备充分者重度疼痛发生率(35.6％,16/45)明显低于对分娩紧张和恐惧者(59.0％,36/61)；情绪控制能力良好的产妇重度疼痛发生率(44.8％,43/96)低于情绪控制不良的产妇(9/10)；应用镇静剂的产妇重度疼痛发生率(29.2％,7/24)低于未用镇静剂的产妇(54.9％,45/82),上述各项比较,差异也均有统计学意义(P＜0.05).(2)分娩结局:潜伏期中度疼痛者胎儿窘迫发生率(36.6％,30/82)、剖宫产率(39.0％,32/82)均显著高于轻度疼痛者(13.8％,4/29和17.2％,5/29),活跃期重度疼痛者胎儿窘迫发生率(36.5％,19/52)、剖宫产率(40.4％,21/52)、产后出血发生率(13.5％,7/52)均显著高于中度疼痛者[分别为18.5％ (10/54)、20.4％ (11/54)和0],差异均有统计学意义(P＜0.05).结论 对分娩认知不良、紧张和恐惧、情绪控制能力差、年轻、初产妇分娩疼痛剧烈；活跃期应用镇静剂可以减轻分娩疼痛；自觉疼痛程度轻的产妇分娩结局好.
目的 評估分娩疼痛程度及其相關因素與分娩結跼.方法 選擇2009年7-12月在浙江中醫藥大學附屬第二醫院住院分娩的正常單胎頭位產婦111例,其中高齡產婦5例,採用視覺模擬評分( VAS)法評估潛伏期、活躍期疼痛程度；評估疼痛相關因素包括孕婦年齡、孕次、產次、職業、文化程度、居住地等.自行設計調查問捲,由經過培訓的專業人員分彆對孕婦進行分娩認知、分娩的心理準備、情緒控製能力、伕妻感情、婆媳關繫、與父母關繫、傢庭經濟狀況的評估,記錄產程中鎮靜劑的應用情況,統計分娩結跼.結果 (1)疼痛相關因素:潛伏期:高齡產婦中度疼痛髮生率(1/5)明顯低于適齡產婦(76.4％,81/106)；對分娩認知良好的產婦中度疼痛髮生率(64.7％,44/68)低于認知不足的產婦(88.4％,38/43)；伕妻感情良好的產婦中度疼痛髮生率(77.2％,78/101)明顯高于感情一般的產婦(4/10);經產婦中度疼痛髮生率明顯低于初產婦,上述各項比較,差異均有統計學意義(P＜0.05).活躍期:進入活躍期的產婦共106例,其中對分娩的心理準備充分者重度疼痛髮生率(35.6％,16/45)明顯低于對分娩緊張和恐懼者(59.0％,36/61)；情緒控製能力良好的產婦重度疼痛髮生率(44.8％,43/96)低于情緒控製不良的產婦(9/10)；應用鎮靜劑的產婦重度疼痛髮生率(29.2％,7/24)低于未用鎮靜劑的產婦(54.9％,45/82),上述各項比較,差異也均有統計學意義(P＜0.05).(2)分娩結跼:潛伏期中度疼痛者胎兒窘迫髮生率(36.6％,30/82)、剖宮產率(39.0％,32/82)均顯著高于輕度疼痛者(13.8％,4/29和17.2％,5/29),活躍期重度疼痛者胎兒窘迫髮生率(36.5％,19/52)、剖宮產率(40.4％,21/52)、產後齣血髮生率(13.5％,7/52)均顯著高于中度疼痛者[分彆為18.5％ (10/54)、20.4％ (11/54)和0],差異均有統計學意義(P＜0.05).結論 對分娩認知不良、緊張和恐懼、情緒控製能力差、年輕、初產婦分娩疼痛劇烈；活躍期應用鎮靜劑可以減輕分娩疼痛；自覺疼痛程度輕的產婦分娩結跼好.
목적 평고분면동통정도급기상관인소여분면결국.방법 선택2009년7-12월재절강중의약대학부속제이의원주원분면적정상단태두위산부111례,기중고령산부5례,채용시각모의평분( VAS)법평고잠복기、활약기동통정도；평고동통상관인소포괄잉부년령、잉차、산차、직업、문화정도、거주지등.자행설계조사문권,유경과배훈적전업인원분별대잉부진행분면인지、분면적심리준비、정서공제능력、부처감정、파식관계、여부모관계、가정경제상황적평고,기록산정중진정제적응용정황,통계분면결국.결과 (1)동통상관인소:잠복기:고령산부중도동통발생솔(1/5)명현저우괄령산부(76.4％,81/106)；대분면인지량호적산부중도동통발생솔(64.7％,44/68)저우인지불족적산부(88.4％,38/43)；부처감정량호적산부중도동통발생솔(77.2％,78/101)명현고우감정일반적산부(4/10);경산부중도동통발생솔명현저우초산부,상술각항비교,차이균유통계학의의(P＜0.05).활약기:진입활약기적산부공106례,기중대분면적심리준비충분자중도동통발생솔(35.6％,16/45)명현저우대분면긴장화공구자(59.0％,36/61)；정서공제능력량호적산부중도동통발생솔(44.8％,43/96)저우정서공제불량적산부(9/10)；응용진정제적산부중도동통발생솔(29.2％,7/24)저우미용진정제적산부(54.9％,45/82),상술각항비교,차이야균유통계학의의(P＜0.05).(2)분면결국:잠복기중도동통자태인군박발생솔(36.6％,30/82)、부궁산솔(39.0％,32/82)균현저고우경도동통자(13.8％,4/29화17.2％,5/29),활약기중도동통자태인군박발생솔(36.5％,19/52)、부궁산솔(40.4％,21/52)、산후출혈발생솔(13.5％,7/52)균현저고우중도동통자[분별위18.5％ (10/54)、20.4％ (11/54)화0],차이균유통계학의의(P＜0.05).결론 대분면인지불량、긴장화공구、정서공제능력차、년경、초산부분면동통극렬；활약기응용진정제가이감경분면동통；자각동통정도경적산부분면결국호.
Objective To evaluate factors associated with labor pain and delivery outcomes.Methods From Jul.to Dec.2009,111 normal singleton cephalic presentation pregnancies (including 5 elderly parturient) who delivered at the Department of Obstetrics and Gynecology,Second Affiliated Hospital,Zhejiang Chinese Medical University were enrolled in this study to evaluate the relationship between factors of labor pain and delivery outcomes.The labor pain of latent phase and active phase were scored by the visual analogue scale (VAS).Factors associated with pain included the age of parturient,the number of gravidity and parity,occupation,education profile,dwell location,etc.The questionnaire was designed by ourselves.Childbirth awareness,psychological preparation of delivery,emotional controllability,couple relationship,the relationship of parturient and mother-in-law,the relationship of parturient and parents,family economic status,use of sedative during the labor process and delivery outcomes were collected and analyzed.Results (1)Factors associated with pain:in the latent phase,the rate of moderate labour pain of 1/5 in women with more than 35 years old was statistically lower than 76.4％ ( 81/106 ) in suitable age group (P＜0.05 ).The women with a good understanding about delivery had a statistically lower rate of moderate pain of 64.7％( 44/68 ) than 88.4％ ( 38/43 ) of those having a poor understanding( P＜0.05 ).The women who had a better couple relationship had a significandy higher rate of moderate pain of 77.2％ (78/101) than 4/10 of those who had a general couple relationship ( P＜0.05 ).There was significant difference in rate of moderate pain between pluripara group ( 50.0％,11/22) and primipara group(79.8％,71/89;P＜0.01 ).In the active phase,women with tense,scared or a poor emotion control expressed significantly severe labour pain(59.0％,36/61 ) than 35.6％ ( 16/45 ) in well-prepared group.The rate of severe labour pain in good control of emotion group of 44.8％ (43/96) was a statistically lower than 9/10 in poor control group.There was a statistically lower severe labour pain in women given by sedatives ( 29.2％,7/24 ) than 54.9％ (45/82) in women without sedatives treatment (P ＜ 0.05).(2) Delivery outcomes:in latent phase,the rates of fetal distress and cesarean section were 36.6％ (30/82) and 39.0％ (32/82) in moderate pain group,which were significantly higher than 13.8％ (4/29) and 17.2％ (5/29) in mild pain group.In active phase,the rate of fetal distress,cesarean section and postpartum hemorrhage were 36.5％ ( 19/52),40.4％ (21/52) and 13.5％ (7/52) in severe pain group,which were significantly higher than [18.5％ (10/54) ;20.4％ (11/54) ;0] in moderate pain group (P＜0.05).Conclusions Women with poor understanding of delivery,tense,scared,poor emotion control,young age and uniparous have severe labour pain.Sedative use could alleviate pain in active phase.Women with mild labour pain have good delivery outcomes.
