助产士主导规范化疼痛管理结合自由体位技术在初产妇经阴道分娩中的应用研究

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摘要 目的: 探究助产士主导规范化疼痛管理结合自由体位技术在经阴道分娩初产妇中的应用效果。方法: 按随机数字表法将2022年1月—2023年12月期间于合肥市妇幼保健院分娩的186例初产妇患者分成对照组（93例）和研究组（93例）。两组均予以常规围生期护理,在此基础上,对照组应用常规疼痛管理,研究组应用助产士主导规范化疼痛管理+自由体位技术。比较两组产妇分娩疼痛视觉模拟评分（VAS）、心理状态、围生期指标、不良分娩结局及椎管内不良反应发生率和产妇满意率的差异。结果: 干预后,两组分娩前VAS评分比较差异无统计学意义,研究组分娩时不同产程、分娩后的VAS评分均低于对照组;两组分娩恐惧量表（CAQ）、妊娠相关焦虑量表（PAQ）评分均低于同组干预前,分娩控制量表（LAS）评分高于同组干预前,且研究组改善程度优于对照组;研究组第一、第二及总产程时间、阴道助产率、中转剖宫产率、缩宫素使用率、缩宫素剂量、产后2h出血量均低于对照组,阴道分娩率、新生儿1min Apgar评分高于对照组,两组第三产程时间比较差异均无统计学意义;两组各项不良分娩结局及椎管内不良反应发生率比较,差异无统计学意义;研究组产妇满意率高于对照组。结论: 助产士主导规范化疼痛管理结合自由体位技术在经阴道分娩初产妇中的干预效果显著,能有效缓解负面心理,改善围生期指标,提高满意度,且镇痛效果确切,安全性好。

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	高玲
	陆天慧
	刘书华
	史景发
	倪娜
	龙玉芬

关键词 ：助产士, 规范化疼痛管理, 自由体位技术, 初产妇, 阴道分娩, 分娩疼痛

Abstract：Objective To explore the application effect of midwife-led standardized pain nursing combined with free position technique in vaginal delivery of primiparas. Methods According to random number table method, 186 primiparas undergoing delivery in Hefei Maternal and Child Health Hospital were divided into control group (93 cases) and study group (93 cases) between January 2022 and December 2023. On basis of routine perinatal nursing, control group was given routine pain management, while study group was given midwife-led standardized pain nursing combined with free position technique. The differences in delivery pain [visual analogue scale (VAS) ], psychological state, perinatal indexes, incidence of adverse delivery outcomes and intraspinal adverse reactions, and satisfaction rate between the two groups were compared. Results Before delivery, there was no significant difference in VAS scores between the two groups. VAS scores in study group were lower than those in control group during different stages of labor and after delivery. After intervention, scores of childbirth attitudes questionnaires (CAQ) and pregnancy-related anxiety questionnaire (PAQ) were decreased, and scores of labor agentry scale (LAS) were increased in both groups, and the improvement was better in study group than control group. The first, second and total stages of labor, vaginal midwifery rate, transfer to cesarean section rate, usage rate of oxytocin, oxytocin dose and blood loss at 2h after delivery in study group were lower than those in control group, while vaginal delivery rate and neonatal 1min Apgar score were higher than those in control group, but difference in the third stage of labor between the two groups was not statistically significant. The difference in incidence of adverse delivery outcomes and intraspinal adverse reactions between the two groups was not statistically significant. The satisfaction rate in study group was higher than that in control group. Conclusion The intervention effect of midwife-led standardized pain nursing combined with free position technique is significant in vaginal delivery of primiparas, which can effectively relieve negative psychology, improve perinatal indexes and satisfaction, with significant analgesic effect and high safety.

Key words： midwife standardized pain management free position technique primipara vaginal delivery delivery pain

收稿日期: 2024-05-27

基金资助:安徽省高校科学研究重点项目“妊娠期糖尿病患者子代脐带血端粒长度变化及其相关机制研究”（2022AH050674）

通讯作者: 刘书华,E-mail：402896355@qq.com

引用本文:

高玲, 陆天慧, 刘书华, 史景发, 倪娜, 龙玉芬. 助产士主导规范化疼痛管理结合自由体位技术在初产妇经阴道分娩中的应用研究[J]. 湖南师范大学学报(医学版), 2024, 21(4): 128-133. GAO Ling, LU Tianhui, LIU Shuhua, SHI Jingfa, NI Na, LONG Yufen. Application of midwife-led standardized pain nursing combined with free position technique in vaginal delivery of primiparas. HuNan ShiFan DaXue XueBao(YiXueBan), 2024, 21(4): 128-133.

链接本文:

http://yxb.hunnu.edu.cn/CN/ 或 http://yxb.hunnu.edu.cn/CN/Y2024/V21/I4/128

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