CAJ | 학술논문

目的：探讨初产妇阴道分娩产程曲线的变化。方法在北京大学第一医院分娩并符合以下条件的产妇纳入研究：初产妇、足月妊娠、单胎妊娠、头先露并经阴道分娩。2009年1月1日至2009年12月31日共1300例，2013年1月1日至2013年5月31日共840例，合计2140例。采用回顾性研究的方法，记录产妇的年龄、分娩孕周、分娩时体重指数、新生儿出生体重、临产时间、宫口扩张程度和时间以及产后24 h出血量等资料。采用独立样本t检验、χ2检验进行统计分析，并计算宫口扩张每进展1 cm所经历的时间。结果（1）2013年与2009年产妇的年龄分别为[（29.6±2.8）与（29.0±3.0）岁，t=4.77]，产后出血发生率分别为[4.3%（36/840）与1.8%（24/1300），χ2=11.17]，引产率分别为[64.0%（538/840）与37.3%（485/1300），χ2=146.23]，分娩镇痛率分别为[61.5%（517/840）与54.2%（705/1300），χ2=11.15]，2013年均高于2009年（P值均<0.01）。（2）宫口扩张进展所经历的时间[中位数（最大值~最小值）]：宫口从3 cm进展至4 cm 为2.2 h（0.8~4.3 h），4 cm 进展至5 cm 为1.9 h（0.6~4.0 h），5 cm 进展至6 cm为1.8 h（0.5~4.0 h），6 cm进展至7 cm为1.6 h（0.5~2.0 h），7 cm进展至8 cm为1.8 h（0.8~2.0 h），8 cm进展至9 cm为1.3 h（0.2~2.5 h），9 cm进展至10 cm为0.6 h（0.1~2.5 h）。以时间为横坐标，宫口扩张程度为纵坐标，绘制的产程曲线图呈缓慢上升趋势。结论产程曲线呈缓慢上升趋势，没有明显的加速期和减速期。需重新定义我国产妇的产程时限和产程进展，以指导临床处理。
목적：탐토초산부음도분면산정곡선적변화。방법재북경대학제일의원분면병부합이하조건적산부납입연구：초산부、족월임신、단태임신、두선로병경음도분면。2009년1월1일지2009년12월31일공1300례，2013년1월1일지2013년5월31일공840례，합계2140례。채용회고성연구적방법，기록산부적년령、분면잉주、분면시체중지수、신생인출생체중、임산시간、궁구확장정도화시간이급산후24 h출혈량등자료。채용독립양본t검험、χ2검험진행통계분석，병계산궁구확장매진전1 cm소경력적시간。결과（1）2013년여2009년산부적년령분별위[（29.6±2.8）여（29.0±3.0）세，t=4.77]，산후출혈발생솔분별위[4.3%（36/840）여1.8%（24/1300），χ2=11.17]，인산솔분별위[64.0%（538/840）여37.3%（485/1300），χ2=146.23]，분면진통솔분별위[61.5%（517/840）여54.2%（705/1300），χ2=11.15]，2013년균고우2009년（P치균<0.01）。（2）궁구확장진전소경력적시간[중위수（최대치~최소치）]：궁구종3 cm진전지4 cm 위2.2 h（0.8~4.3 h），4 cm 진전지5 cm 위1.9 h（0.6~4.0 h），5 cm 진전지6 cm위1.8 h（0.5~4.0 h），6 cm진전지7 cm위1.6 h（0.5~2.0 h），7 cm진전지8 cm위1.8 h（0.8~2.0 h），8 cm진전지9 cm위1.3 h（0.2~2.5 h），9 cm진전지10 cm위0.6 h（0.1~2.5 h）。이시간위횡좌표，궁구확장정도위종좌표，회제적산정곡선도정완만상승추세。결론산정곡선정완만상승추세，몰유명현적가속기화감속기。수중신정의아국산부적산정시한화산정진전，이지도림상처리。
Objective To analyze labor duration in nulliparous women and discuss the change about curve of labor duration. Methods Two thousand, one hundred and forty nulliparous, full-term pregnant, singleton, cephalic presentation and vaginal delivery women who delivered at Peking University First Hospital were included. There were 1 300 cases between January 1, and December 31, 2009, while 840 cases between January 1, and May 31, 2013. A retrospective study was conducted. Data on maternal age, gestational age at delivery, body mass index at delivery, newborn weight, time of labor initiation, cervical dilatation and the amount of bleeding within the first 24 h after delivery were recorded. Data were compared by t test and χ2 test. The median time span corresponding to one-centimeter-increase in cervical dilatation was calculated. Results (1)Compared with data from 2009, the maternal age [(29.0±3.0) vs (29.6±2.8) years, t=4.77], incidence of postpartum hemorrhage [1.8%(24/1 300) vs 4.3%(36/840),χ2=11.17], proportion of induced labor [37.3%(485/1 300) vs 64.0%(538/840),χ2=146.23] and proportion of analgesia during labor [54.2%(705/1 300) vs 61.5% (517/840), χ2=11.15] were all higher in 2013 (all P<0.01). (2)The median (minimum–maximum) time span corresponding to a one-centimeter-increase in cervical dilatation was 3-4 cm which corresponded to 2.2 h(0.8-4.3 h), 4-5 cm which corresponded to 1.9 h(0.6-4.0 h), 5-6 cm which corresponded to 1.8 h(0.5-4.0 h), 6-7 cm which corresponded to 1.6 h(0.5-2.0 h), 7-8 cm which corresponded to 1.8 h(0.8-2.0 h), 8-9 cm which corresponded to 1.3 h(0.2-2.5 h), and 9-10 cm which corresponded to 0.6 h(0.1-2.5 h). The curve of labor duration showed a slow uptrend with time on the horizontal axis and cervical dilatation on the vertical axis. Conclusions The curve of labor duration exhibits a slow uptrend with neither an acceleration phase nor a deceleration phase. It is important to redefine the time span of labor duration in China for appropriate clinical treatment.