CAJ | 학술논문

目的：探讨会阴无保护接生技术在低危孕妇正常分娩中的应用效果。方法便利抽样法选择2013年1-9月在唐县人民医院拟经阴道分娩的初产妇360例为研究对象。按随机数字表法将其分为观察组和对照组，每组180例。观察组于宫口开全胎头着冠后，助产士指导产妇屏气和哈气，在无保护会阴状态下分娩；对照组采用传统保护会阴的接生方法进行接产。比较两组产妇软产道裂伤、产后出血、产程时间、新生儿窒息等情况。结果观察组产妇的会阴侧切率为22.2％，而对照组的会阴侧切率为75.0％，差异有统计学意义（P<0.001）；产后出血率（2.2％）较对照组（13.9％）显著降低（P<0.001）；两组产妇均未出现会阴III °裂伤，其中观察组I °裂伤率高于对照组，而II °裂伤率低于对照组(P=0.001)；观察组三个产程及总产程用时均比对照组短，两组比较差异有统计学意义（P<0.001）。两组产妇的新生儿窒息率差异无统计学意义（P>0.05）。结论会阴无保护接生可降低会阴侧切率，减少会阴切口感染，提高分娩舒适感，促进自然分娩率，同时降低产后出血的发生率，具有可行性。
목적：탐토회음무보호접생기술재저위잉부정상분면중적응용효과。방법편리추양법선택2013년1-9월재당현인민의원의경음도분면적초산부360례위연구대상。안수궤수자표법장기분위관찰조화대조조，매조180례。관찰조우궁구개전태두착관후，조산사지도산부병기화합기，재무보호회음상태하분면；대조조채용전통보호회음적접생방법진행접산。비교량조산부연산도렬상、산후출혈、산정시간、신생인질식등정황。결과관찰조산부적회음측절솔위22.2％，이대조조적회음측절솔위75.0％，차이유통계학의의（P<0.001）；산후출혈솔（2.2％）교대조조（13.9％）현저강저（P<0.001）；량조산부균미출현회음III °렬상，기중관찰조I °렬상솔고우대조조，이II °렬상솔저우대조조(P=0.001)；관찰조삼개산정급총산정용시균비대조조단，량조비교차이유통계학의의（P<0.001）。량조산부적신생인질식솔차이무통계학의의（P>0.05）。결론회음무보호접생가강저회음측절솔，감소회음절구감염，제고분면서괄감，촉진자연분면솔，동시강저산후출혈적발생솔，구유가행성。
Objective To discuss application and effects of technique of unprotected perineum delivery in pregnant women. Methods 360 primiparas expecting to have vaginal delivery from January to September 2013 in Tangxian People’s Hospital were selected by convenient sampling and randomly and equally divided into the observation group and the control group. In observation group, midwife would direct the pregnant women to hold her breath and breathe when uterine neck whole opened and fetal head crowned and helped them give birth to a baby under state of unprotected perineum. In the control group, traditional delivery method was chosen. Comparison of soft birth canal laceration, postpartum hemorrhage, duration of delivery, neonatal asphyxia and so on between the two groups was made. Results Rate of lateral episiotomy and of postpartum hemorrhage in the observation group were demonstrated 22.2%and 2.2%, which were obviously lower than that of 75.0%and 13.9%in the control group. The difference had statistical signiifcance (P<0.001). Both groups had no III laceration. However, occurrence rate of I laceration observed was higher in the observation group than that in the control group, on the contrary, rate of II laceration was lower (P=0.001). Duration of 3 birth processes or the whole delivery in the observation group were shorter, and difference between the two groups had statistical significance (P<0.001). There was no statistical significance in the difference of neonatal asphyxia between the two groups (P>0.05). Conclusion Unprotected perineum delivery could reduce occurrence rate of lateral episiotomy and infection of perineum incision, improve comfort of delivery and occurrence rate of natural delivery, and meanwhile decrease occurrence rate of postpartum hemorrhage. Therefore, the unprotected perineum delivery was feasible in clinical practices.