中国妇幼健康研究
中國婦幼健康研究
중국부유건강연구
CHINESE JOURNAL OF MATERNAL AND CHILD HEALTH RESEARCH
2015年
2期
331-334
,共4页
罗晓菊%吴方银%陈本祯%肖兵%吕行%李远萍%张瑞
囉曉菊%吳方銀%陳本禎%肖兵%呂行%李遠萍%張瑞
라효국%오방은%진본정%초병%려행%리원평%장서
自然分娩%助产%服务现状%问卷调查
自然分娩%助產%服務現狀%問捲調查
자연분면%조산%복무현상%문권조사
natural childbirth%midwifery%current status of clinical service%questionnaire survey
目的：了解四川省自然分娩助产服务现状，为改善助产质量提供资料。方法对四川省21个市（州）产科服务机构进行抽样问卷调查，了解其目前的临床服务方式，以世界卫生组织正常分娩实践指南为标准进行对比。结果目前临床助产服务机构在A类临床实践行为（应予鼓励和有益的方式）使用率不足50％，二甲以上医院较下级医院执行程度好。在A类方法中，“有温馨一体化产房”“有分娩支持的工具分娩球步行车”“有淋浴设施”在不同级别的机构中差异均有统计学意义（χ2值分别为9．666、8．337、16．132，均P＜0．05），而“有饮食支持”“医院提供饮食”“产房有产妇专用座椅”“允许家属陪伴及全程陪护”在不同级别的机构中无统计学意义（χ2值分别为1．483、3．820、2．234、1．483，均P＞0．05）；B类临床实践行为（应该淘汰的明显有害或无效的方法）仍在惯性沿用达50％～100％，90％以上的医院采取仰卧位接生体位（χ2＝1．105，P＞0．05），大多数医院仍然沿用传统的直肠检查宫口、常规剔除阴毛、常规静脉输液等产程方法，各级医院间使用情况差异均无统计学意义（χ2值分别为4．1553、6．999、1．560、5．120，均P＞0．05）；C类是建议应谨慎使用，并需要进一步研究的方法，除二甲以上医院合理使用抗生素执行较合理（χ2＝16．868，P＜0．05），而产程中的人为干预措施高“第一产程常规早期人工破膜”“第二产程宫底加腹压”“产后常规使用缩宫素”等各级别医院间差异均无统计学意义（χ2值分别为5．169、3．476、6．132均P＞0．05）；在D类（常用的但不适当的）方法中，除外有“有温馨一体化产房”设备的医院，其它医院均是将产妇不断转移至不同的房间待产、分娩、产后观察；级别高的医院会阴侧切率，胎膜早破者常规平卧位使用率均低于级别低的医院，而临产后全程胎心监测在级别高的医院使用率高于级别低的医院，差异均有统计学意义（ F＝6．529；χ2值分别为13．666、37．425，均P＜0．05）。结论要加强助产适宜技术培训，推广产科服务新理念，促使自然正常分娩；做好逐层培训，建立有效的机制。
目的：瞭解四川省自然分娩助產服務現狀，為改善助產質量提供資料。方法對四川省21箇市（州）產科服務機構進行抽樣問捲調查，瞭解其目前的臨床服務方式，以世界衛生組織正常分娩實踐指南為標準進行對比。結果目前臨床助產服務機構在A類臨床實踐行為（應予鼓勵和有益的方式）使用率不足50％，二甲以上醫院較下級醫院執行程度好。在A類方法中，“有溫馨一體化產房”“有分娩支持的工具分娩毬步行車”“有淋浴設施”在不同級彆的機構中差異均有統計學意義（χ2值分彆為9．666、8．337、16．132，均P＜0．05），而“有飲食支持”“醫院提供飲食”“產房有產婦專用座椅”“允許傢屬陪伴及全程陪護”在不同級彆的機構中無統計學意義（χ2值分彆為1．483、3．820、2．234、1．483，均P＞0．05）；B類臨床實踐行為（應該淘汰的明顯有害或無效的方法）仍在慣性沿用達50％～100％，90％以上的醫院採取仰臥位接生體位（χ2＝1．105，P＞0．05），大多數醫院仍然沿用傳統的直腸檢查宮口、常規剔除陰毛、常規靜脈輸液等產程方法，各級醫院間使用情況差異均無統計學意義（χ2值分彆為4．1553、6．999、1．560、5．120，均P＞0．05）；C類是建議應謹慎使用，併需要進一步研究的方法，除二甲以上醫院閤理使用抗生素執行較閤理（χ2＝16．868，P＜0．05），而產程中的人為榦預措施高“第一產程常規早期人工破膜”“第二產程宮底加腹壓”“產後常規使用縮宮素”等各級彆醫院間差異均無統計學意義（χ2值分彆為5．169、3．476、6．132均P＞0．05）；在D類（常用的但不適噹的）方法中，除外有“有溫馨一體化產房”設備的醫院，其它醫院均是將產婦不斷轉移至不同的房間待產、分娩、產後觀察；級彆高的醫院會陰側切率，胎膜早破者常規平臥位使用率均低于級彆低的醫院，而臨產後全程胎心鑑測在級彆高的醫院使用率高于級彆低的醫院，差異均有統計學意義（ F＝6．529；χ2值分彆為13．666、37．425，均P＜0．05）。結論要加彊助產適宜技術培訓，推廣產科服務新理唸，促使自然正常分娩；做好逐層培訓，建立有效的機製。
목적：료해사천성자연분면조산복무현상，위개선조산질량제공자료。방법대사천성21개시（주）산과복무궤구진행추양문권조사，료해기목전적림상복무방식，이세계위생조직정상분면실천지남위표준진행대비。결과목전림상조산복무궤구재A류림상실천행위（응여고려화유익적방식）사용솔불족50％，이갑이상의원교하급의원집행정도호。재A류방법중，“유온형일체화산방”“유분면지지적공구분면구보행차”“유림욕설시”재불동급별적궤구중차이균유통계학의의（χ2치분별위9．666、8．337、16．132，균P＜0．05），이“유음식지지”“의원제공음식”“산방유산부전용좌의”“윤허가속배반급전정배호”재불동급별적궤구중무통계학의의（χ2치분별위1．483、3．820、2．234、1．483，균P＞0．05）；B류림상실천행위（응해도태적명현유해혹무효적방법）잉재관성연용체50％～100％，90％이상적의원채취앙와위접생체위（χ2＝1．105，P＞0．05），대다수의원잉연연용전통적직장검사궁구、상규척제음모、상규정맥수액등산정방법，각급의원간사용정황차이균무통계학의의（χ2치분별위4．1553、6．999、1．560、5．120，균P＞0．05）；C류시건의응근신사용，병수요진일보연구적방법，제이갑이상의원합리사용항생소집행교합리（χ2＝16．868，P＜0．05），이산정중적인위간예조시고“제일산정상규조기인공파막”“제이산정궁저가복압”“산후상규사용축궁소”등각급별의원간차이균무통계학의의（χ2치분별위5．169、3．476、6．132균P＞0．05）；재D류（상용적단불괄당적）방법중，제외유“유온형일체화산방”설비적의원，기타의원균시장산부불단전이지불동적방간대산、분면、산후관찰；급별고적의원회음측절솔，태막조파자상규평와위사용솔균저우급별저적의원，이임산후전정태심감측재급별고적의원사용솔고우급별저적의원，차이균유통계학의의（ F＝6．529；χ2치분별위13．666、37．425，균P＜0．05）。결론요가강조산괄의기술배훈，추엄산과복무신이념，촉사자연정상분면；주호축층배훈，건립유효적궤제。
Objective To investigate the current status of natural childbirth midwifery services of Sichuan Province and to provide information for improving the quality of midwifery.Methods Questionnaire survey of obstetric service institutions in 21states of Sichuan Province was conducted to understand the current services.Normal childbirth practice guidelines of the world health organization ( WHO) was taken as standard.Results The utilization rate of class A practice ( encouraged and beneficial way) in current clinical obstetric service institutions was less than 50%.The execution in second-grade class-A hospitals or above was better than lower-leveled hospitals.In class A method, there were significant differences in the different levels of institutions in the aspects of a sweet integration room, labor support tools, and shower facilities (χ2 value was 9.666, 8.337 and 16.132, respectively, all P <0.05), and there were no significant differences in the aspects of food supply, providing food and drink by hospital, delivery room with maternal special seat, and allowing family members to accompany and full escort (χ2 value was 1.483, 3.820, 2.234 and 1.483, respectively, all P>0.05).Class B clinical practice ( be eliminated or obviously harmful or invalid) was still used in 50%-100% hospitals.More than 90% of the hospitals took supine position (χ2 =1.105, P >0.05), and most hospitals still used traditional rectal examination, rejecting pubic hair and intravenous transfusion.There were no significant differences among different hospitals(χ2 value was 4.1553, 6.999, 1.560 and 5.120, respectively, all P >0.05 ) .Class C methods were recommended to be carefully used and needed further research.There were no significant differences in the aspects of artificial intervention measures in labor such as routine artificial rupture of fetal membrane in the first early stage of labor, increasing abdominal pressure at the bottom of the uterus, and routine use of oxytocin postpartum (χ2 value was 5.169, 3.476 and 6.132, respectively, all P>0.05) except that reasonable use of antibiotics in second-grade class-A hospitals (χ2 =16.868,P<0.05).As for class D methods (common but inappropriate), except for hospitals with sweet integration room equipment, the pregnant women were constantly shift to a different room for delivery and postpartum observation.The episiotomy rate and usage of horizontal position in premature rupture of membranes women were lower in high leveled hospitals than in low leveled hospitals, while the rate of fetal heart monitor in whole stage of labor was higher in high leveled hospitals than in low leveled hospitals (F=6.529,χ2 value was 13.666 and 37.425, respectively, both P<0.05).Conclusion Appropriate technologies of midwifery training should be strengthened, and new ideas of obstetric service should be generalized to promote natural normal childbirth.An effective mechanism should be established to do a good job in training step by step.
