CAJ | 학술논문

目的：探讨自由体位分娩对母婴围生期结局的影响。方法回顾性分析2013年5月至2014年5月于第三军医大学第一附属医院产科住院分娩的960例低危、足月初产妇的临床病历资料为研究对象。按照随机数字表法,将其分为研究组(n=480)和对照组(n=480)。研究组产妇于第一产程取自由体位待产,第二产程取胱截石位加床头抬高(30°~45°)分娩。对照组产妇第一产程取仰卧位或侧卧位待产,第二产程取膀胱截石位分娩。比较两组产妇的分娩方式、会阴侧切率、各产程持续时间、经阴道分娩新生儿生后1,5 min Apgar 评分和经阴道分娩新生儿生后1,5 min 窒息发生率。本研究遵循的程序符合第三军医大学第一附属医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象本人及其家属的同意,并与之签署临床研究知情同意书。结果①研究组产妇的阴道顺产率高于对照组(87.9% vs 59.2%),但其阴道助产率和剖宫产率均低于对照组(1.2% vs 7.5%,10.8% vs 33.3%),两组比较,差异均有统计学意义(χ2=10.26,5.11,8.67；P <0.05)。②研究组产妇会阴侧切率为15.0%(64/428),对照组为41.6%(133/320),两组比较,差异有统计学意义(χ2=893,P <0.01)。③研究组阴道分娩产妇的第一产程时间、第二产程时间及总产程时间均短于对照组[(488.3±147.8)min vs (643.6±133.6)min,(30.5±16.6)min vs (58.6±13.2)min,(536.7±159.4)min vs (662.6±161.5)min],并且差异均有统计学意义(t=4.73,3.62,3.87；P <0.05)。④研究组新生儿生后1 min 和5 min 窒息发生率均低于对照组,并且差异有统计学意义(χ2=6.43,5.07；P <0.05)。研究组新生儿生后1 min 和5 min Apgar 评分均高于对照组,并且差异均无统计学意义(t=0.48,0.64；P >0.05)。结论自由体位分娩可促进阴道分娩,减少医疗干预,利于母婴健康。
목적：탐토자유체위분면대모영위생기결국적영향。방법회고성분석2013년5월지2014년5월우제삼군의대학제일부속의원산과주원분면적960례저위、족월초산부적림상병력자료위연구대상。안조수궤수자표법,장기분위연구조(n=480)화대조조(n=480)。연구조산부우제일산정취자유체위대산,제이산정취광절석위가상두태고(30°~45°)분면。대조조산부제일산정취앙와위혹측와위대산,제이산정취방광절석위분면。비교량조산부적분면방식、회음측절솔、각산정지속시간、경음도분면신생인생후1,5 min Apgar 평분화경음도분면신생인생후1,5 min 질식발생솔。본연구준순적정서부합제삼군의대학제일부속의원인체시험위원회소제정적윤리학표준,득도해위원회비준,정득수시대상본인급기가속적동의,병여지첨서림상연구지정동의서。결과①연구조산부적음도순산솔고우대조조(87.9% vs 59.2%),단기음도조산솔화부궁산솔균저우대조조(1.2% vs 7.5%,10.8% vs 33.3%),량조비교,차이균유통계학의의(χ2=10.26,5.11,8.67；P <0.05)。②연구조산부회음측절솔위15.0%(64/428),대조조위41.6%(133/320),량조비교,차이유통계학의의(χ2=893,P <0.01)。③연구조음도분면산부적제일산정시간、제이산정시간급총산정시간균단우대조조[(488.3±147.8)min vs (643.6±133.6)min,(30.5±16.6)min vs (58.6±13.2)min,(536.7±159.4)min vs (662.6±161.5)min],병차차이균유통계학의의(t=4.73,3.62,3.87；P <0.05)。④연구조신생인생후1 min 화5 min 질식발생솔균저우대조조,병차차이유통계학의의(χ2=6.43,5.07；P <0.05)。연구조신생인생후1 min 화5 min Apgar 평분균고우대조조,병차차이균무통계학의의(t=0.48,0.64；P >0.05)。결론자유체위분면가촉진음도분면,감소의료간예,리우모영건강。
Objective To investigate the effects of free position during delivery on maternal and perinatal outcomes.Methods Clinical data of 960 cases of low risk primiparas delivering in our labor room from May 2013 to May 2014 were retrospectively analyzed.All primiparas were randomly divided into study group (n=480)and control group (n=480).Primiparas in the study group were in free position during the first stage of labor and in bladder lithotomy position with semireclining position during the second stage of labor.Primiparas in the control group were in supine position or lateral position during the first stage of labor and in bladder lithotomy position during the second stage of labor.Delivery mode,episiotomy rate, time of birth process,Apgar score of newborns and incidence of neonatal asphyxia at 1,5 min after birth were compared.This study followed the ethical standards set out by the human trial committee of the First Affiliated Hospital of Third Military Medical University.It was approved by the committee,with the consent of the subjects themselves and their families.Meanwhile,a clinical research informed consent was signed between us.Results ① Rate of vaginal delivery was higher in study group than that in control group (87.9% vs 59.2%),and episiotomy rate and cesarean section rate were lower in study group than those in control group (1.2% vs 7.5%,10.8% vs 33.3%).There were statistically significant difference in these indexes between two groups (χ2 =10.26,5.1 1,8.67;P <0.05).② Episiotomy rate was 1 5.0% (64/428) in study group and 41.6% (133/320)in control group with statistically significant difference (χ2 =893,P <0.01).③ Duration of the first stage of labor,second stage of labor and total stage of labor were shorter in study group than those in control group with statistically significant difference [(488.3 ± 147.8 )min vs (643.6±133.6)min,(30.5 ± 1 6.6 )min vs (58.6 ± 13.2 )min,(536.7 ± 1 59.4 )min vs (662.6 ± 1 61.5)min,t=4.73,3.62,3.87;P <0.05].④ Incidence of neonatal asphyxia at 1,5 min after birth were lower in study group than those in control group with statistically significant difference (χ2 = 6.43,5.07;P <0.05).Apgar score of newborns at 1,5 min after birth were higher in study group than those in control group without statistically significant difference (t = 0.48,0.64;P > 0.05 ).Conclusions Free position could promote natural delivery,reduce medical intervention and be good for maternal and fetal health.