改变产妇体位对促进产程进展的临床探讨

目的 探讨产妇在第一产程和第二产程各采取不同分娩体位对促进产程进展和自然分娩的效果.方法 选择孕37～41周头位分娩初产妇152例,随机分为2组,观察组(80例)第一产程可选择行、走、蹲、侧卧、半卧等自主体位;第二产程采取半卧位,胎头拨露时采取截石位.对照组(72例)产妇第一产程采取卧位(平卧、侧卧交替),第二产程采取截石位.观察2组产程进展和产妇舒适度的变化.结果 观察组第一产程(361.83±58.02)min,第二产程(36.39 4-11.97)min,总产程(398.21±59.72)min;对照组第一产程(560.85±131.98)min,第二产程(58.11±15.44)min,总产程(618.96±139.61)min.观察组较对照组各产程时间均缩短(t值分别为12.24、9.74、12.90,P均<0.01).观察组产后2 h下肢酸麻13例,对照组25例;观察组产后12 h下肢酸麻2例,对照组10例.观察组较对照组不同时段产妇舒适度增加(x2值分别为6.90、5.28,P<0.01、P<0.05).结论 第一产程自主体位及第二产程半卧位可有效缩短产程并缓解产后不适.

Abstract：

Objective To discuss the effect on promoting the progress of the stage of labor and the natural delivery as the parturient adopts the different delivery position in the first and the second stage of labor. Methods One hundred and fifty-two cases of delivery primiparas of cephalic presentation whose pregnancy was from 37 to 41 weeks were enrolled and divided into two groups randomly. In the observation group (80 cases) ,the free positions of delivery like walking,squating,lateral position,half lying and others could be selected in the first stage of labor, the semi-reclining position was selected in the second stage of labor and the lithotomy position was adopted when the head was visible on vulvae gapping. The parturient in the control group (72 cases) selected the decubitus (alternation between prostration and lateral position) in the first stage of labor and the parturient selected routine lithotomy position of supine position in the second stage of labor. The progress of labor and the comfort of the parturient in the two groups were observed. Results In the observation group, time spent in the first stage and second stage were (361. 83 ± 58. 02) mins and (36. 39 ± 11. 97) mins, and (398.21 ±59. 72) mins in the total birth process, which were significantly shorter than those of (560.85 ± 131. 98)mins and (58.11 ± 15.44) mins, and (618. 96 ± 139. 61) mins, respectively (t = 12. 24,9. 74 and 12. 90, Ps <0. 01). There were 13 and 25 cases experienced tingle in two hours after delivery, and 2 and 10 cases in 12 hs after delivery, in the observation and control group, respectively. The comfort of parturient in the observation group was higher than that in the control group (x2 = 6. 90, P < 0.01; x2 = 5. 28, P < 0. 05)respectively. Conclusion The free position in the first stage of labor and the semi-reclining position in the second stage of labor can shorten the birth process effectively and relieve the discomfort after the delivery.     

渐进性肌肉放松训练结合健康教育对维持性血液透析患者的影响

Objective To evaluate the effect of progressive muscle relaxation combined with health education on the psychological state of the maintained hemodialysis patients and provide basis for the psychological intervention for them. Methods Forty-two MHD patients were randomly assigned to the intervention group and control group. Patients in the control group received the conventional nursing, and patients in the intervention group received the conventional therapy combined with nursing intervention for two times. Results After the first intervention, the various psychological testing indicators of intervention group were obviously lower than those of control group and there was statistically significant difference between two groups(P ＜ 0. 05 ). The differences of index of physiological chemistry between two groups had no statistical significance (P ＞ 0. 05 ). After the second intervention, the various psychological testing indicators of intervention group were further lower than those of control group and there was statistical significant difference ( P ＜ 0. 01 or P ＜ 0. 05 ). The Hb and Ca2 + of the intervention group were remarkably higher than control group,while PO43+ and K+ of intervention group were significantly lower than control group. Both differences had statistical significance(P ＜ 0. 05 ). Conclusions Progressive muscle relaxation combined with health education can greatly improve the psychological and physiological status of MHD patients.     

饮食教育预防骨科术后病人便秘的研究

Objective To study the effect of diet education on preventing constipation among orthopedic inpafients, and the relationship between diet education and food - taking pattern of postoperative pa-tients. Methods 97 orthopedic inpafients who have been operated on spine were randomly divided into experimen-tal group (n =48) and control group (n = 49) . Patients in experimental group were given diet education at the operation day and second day after operation. Patients in control group were given routine intervention. The sorts and amounts of food taken in the three days after operation and defecation score were collected. Results The rate of vegetable taken by patients in the second and third day after operation in experimental group was higher than that in control group(X<'2> =6.95;7. 24;all P <0.05) ;The amount of staple food taken by patients at the first and sec-ond day after operation in experimental group was higher than that in control group (t= 2.077 ;3. 084;all P <0.05) ;The amount of vegetable taken by patients at the second and third day after operation in experimental group was higher than that in control group (t=0.025 ;2.341 ;all P<0.05 ). Defecation score of patients in experimental group (6.85±3.32) was lower than that of control group(8.63±3.27 ), (t=2.66 P<0.05 ). Conclusions Di-et education can prevent constipation of these patients after operation. The inadequate amount of staple food and vegetable were the main unreasonableness that exists among these patients. So the adequate amount of staple food and vegetable should be emphasized when diet education is given and we should take the condition of patients tak-ing food more serious in three days after operation.     

小剂量肝素干预治疗热射病非显性DIC患者的临床观察

Objective To investigate the therapeutic effect and safety of low-dose heparin therapy for heat stroke with pre-diffuse intravascular coagulation (pre-DIC). Methods 35 cases of heat stroke with preDIC were randomly divided into two groups, 18 cases were treated with low-dose heparin therapy (treatment group, n = 22, given heparion by 70U/kg for 3 days, 24 hours of continuous pump), 17 cases were treated with conventional therapy(control group). The incidence of DIC and mortality in two groups were observed and compared. Results Incidence of DIC and mortality in treatment group were significant lower than those in control group(P ＜0. 05). After the treatment group therapy, a statistically significant increase BPC (P＜ 0. 01). No significant differences APTT PT, (P ＞ 0.05). Conclusion Low-dose heparion is applied early in heat stroke patients in pre-DIC stage, which could not only prevent efficiently DIC, but also diminish mortality.     

饮食教育预防骨科术后病人便秘的研究

Objective To study the effect of diet education on preventing constipation among orthopedic inpafients, and the relationship between diet education and food - taking pattern of postoperative pa-tients. Methods 97 orthopedic inpafients who have been operated on spine were randomly divided into experimen-tal group (n =48) and control group (n = 49) . Patients in experimental group were given diet education at the operation day and second day after operation. Patients in control group were given routine intervention. The sorts and amounts of food taken in the three days after operation and defecation score were collected. Results The rate of vegetable taken by patients in the second and third day after operation in experimental group was higher than that in control group(X<'2> =6.95;7. 24;all P <0.05) ;The amount of staple food taken by patients at the first and sec-ond day after operation in experimental group was higher than that in control group (t= 2.077 ;3. 084;all P <0.05) ;The amount of vegetable taken by patients at the second and third day after operation in experimental group was higher than that in control group (t=0.025 ;2.341 ;all P<0.05 ). Defecation score of patients in experimental group (6.85±3.32) was lower than that of control group(8.63±3.27 ), (t=2.66 P<0.05 ). Conclusions Di-et education can prevent constipation of these patients after operation. The inadequate amount of staple food and vegetable were the main unreasonableness that exists among these patients. So the adequate amount of staple food and vegetable should be emphasized when diet education is given and we should take the condition of patients tak-ing food more serious in three days after operation.     

饮食教育预防骨科术后病人便秘的研究

Objective To study the effect of diet education on preventing constipation among orthopedic inpafients, and the relationship between diet education and food - taking pattern of postoperative pa-tients. Methods 97 orthopedic inpafients who have been operated on spine were randomly divided into experimen-tal group (n =48) and control group (n = 49) . Patients in experimental group were given diet education at the operation day and second day after operation. Patients in control group were given routine intervention. The sorts and amounts of food taken in the three days after operation and defecation score were collected. Results The rate of vegetable taken by patients in the second and third day after operation in experimental group was higher than that in control group(X<'2> =6.95;7. 24;all P <0.05) ;The amount of staple food taken by patients at the first and sec-ond day after operation in experimental group was higher than that in control group (t= 2.077 ;3. 084;all P <0.05) ;The amount of vegetable taken by patients at the second and third day after operation in experimental group was higher than that in control group (t=0.025 ;2.341 ;all P<0.05 ). Defecation score of patients in experimental group (6.85±3.32) was lower than that of control group(8.63±3.27 ), (t=2.66 P<0.05 ). Conclusions Di-et education can prevent constipation of these patients after operation. The inadequate amount of staple food and vegetable were the main unreasonableness that exists among these patients. So the adequate amount of staple food and vegetable should be emphasized when diet education is given and we should take the condition of patients tak-ing food more serious in three days after operation.     

饮食教育预防骨科术后病人便秘的研究

Objective To study the effect of diet education on preventing constipation among orthopedic inpafients, and the relationship between diet education and food - taking pattern of postoperative pa-tients. Methods 97 orthopedic inpafients who have been operated on spine were randomly divided into experimen-tal group (n =48) and control group (n = 49) . Patients in experimental group were given diet education at the operation day and second day after operation. Patients in control group were given routine intervention. The sorts and amounts of food taken in the three days after operation and defecation score were collected. Results The rate of vegetable taken by patients in the second and third day after operation in experimental group was higher than that in control group(X<'2> =6.95;7. 24;all P <0.05) ;The amount of staple food taken by patients at the first and sec-ond day after operation in experimental group was higher than that in control group (t= 2.077 ;3. 084;all P <0.05) ;The amount of vegetable taken by patients at the second and third day after operation in experimental group was higher than that in control group (t=0.025 ;2.341 ;all P<0.05 ). Defecation score of patients in experimental group (6.85±3.32) was lower than that of control group(8.63±3.27 ), (t=2.66 P<0.05 ). Conclusions Di-et education can prevent constipation of these patients after operation. The inadequate amount of staple food and vegetable were the main unreasonableness that exists among these patients. So the adequate amount of staple food and vegetable should be emphasized when diet education is given and we should take the condition of patients tak-ing food more serious in three days after operation.     

饮食教育预防骨科术后病人便秘的研究

Objective To study the effect of diet education on preventing constipation among orthopedic inpafients, and the relationship between diet education and food - taking pattern of postoperative pa-tients. Methods 97 orthopedic inpafients who have been operated on spine were randomly divided into experimen-tal group (n =48) and control group (n = 49) . Patients in experimental group were given diet education at the operation day and second day after operation. Patients in control group were given routine intervention. The sorts and amounts of food taken in the three days after operation and defecation score were collected. Results The rate of vegetable taken by patients in the second and third day after operation in experimental group was higher than that in control group(X<'2> =6.95;7. 24;all P <0.05) ;The amount of staple food taken by patients at the first and sec-ond day after operation in experimental group was higher than that in control group (t= 2.077 ;3. 084;all P <0.05) ;The amount of vegetable taken by patients at the second and third day after operation in experimental group was higher than that in control group (t=0.025 ;2.341 ;all P<0.05 ). Defecation score of patients in experimental group (6.85±3.32) was lower than that of control group(8.63±3.27 ), (t=2.66 P<0.05 ). Conclusions Di-et education can prevent constipation of these patients after operation. The inadequate amount of staple food and vegetable were the main unreasonableness that exists among these patients. So the adequate amount of staple food and vegetable should be emphasized when diet education is given and we should take the condition of patients tak-ing food more serious in three days after operation.     

饮食教育预防骨科术后病人便秘的研究

Objective To study the effect of diet education on preventing constipation among orthopedic inpafients, and the relationship between diet education and food - taking pattern of postoperative pa-tients. Methods 97 orthopedic inpafients who have been operated on spine were randomly divided into experimen-tal group (n =48) and control group (n = 49) . Patients in experimental group were given diet education at the operation day and second day after operation. Patients in control group were given routine intervention. The sorts and amounts of food taken in the three days after operation and defecation score were collected. Results The rate of vegetable taken by patients in the second and third day after operation in experimental group was higher than that in control group(X<'2> =6.95;7. 24;all P <0.05) ;The amount of staple food taken by patients at the first and sec-ond day after operation in experimental group was higher than that in control group (t= 2.077 ;3. 084;all P <0.05) ;The amount of vegetable taken by patients at the second and third day after operation in experimental group was higher than that in control group (t=0.025 ;2.341 ;all P<0.05 ). Defecation score of patients in experimental group (6.85±3.32) was lower than that of control group(8.63±3.27 ), (t=2.66 P<0.05 ). Conclusions Di-et education can prevent constipation of these patients after operation. The inadequate amount of staple food and vegetable were the main unreasonableness that exists among these patients. So the adequate amount of staple food and vegetable should be emphasized when diet education is given and we should take the condition of patients tak-ing food more serious in three days after operation.     

饮食教育预防骨科术后病人便秘的研究

Objective To study the effect of diet education on preventing constipation among orthopedic inpafients, and the relationship between diet education and food - taking pattern of postoperative pa-tients. Methods 97 orthopedic inpafients who have been operated on spine were randomly divided into experimen-tal group (n =48) and control group (n = 49) . Patients in experimental group were given diet education at the operation day and second day after operation. Patients in control group were given routine intervention. The sorts and amounts of food taken in the three days after operation and defecation score were collected. Results The rate of vegetable taken by patients in the second and third day after operation in experimental group was higher than that in control group(X<'2> =6.95;7. 24;all P <0.05) ;The amount of staple food taken by patients at the first and sec-ond day after operation in experimental group was higher than that in control group (t= 2.077 ;3. 084;all P <0.05) ;The amount of vegetable taken by patients at the second and third day after operation in experimental group was higher than that in control group (t=0.025 ;2.341 ;all P<0.05 ). Defecation score of patients in experimental group (6.85±3.32) was lower than that of control group(8.63±3.27 ), (t=2.66 P<0.05 ). Conclusions Di-et education can prevent constipation of these patients after operation. The inadequate amount of staple food and vegetable were the main unreasonableness that exists among these patients. So the adequate amount of staple food and vegetable should be emphasized when diet education is given and we should take the condition of patients tak-ing food more serious in three days after operation.     

初产妇分娩镇痛中第二产程腹压时机对产妇分娩结局的影响

目的探讨分娩镇痛的初产妇第二产程中不同时机的腹压对产妇分娩结局的影响。方法选取2019年6月至2020年5月苏州市立医院北区产科收治的120例经阴道分娩的初产妇,按随机数字表分为两组,对照组(60例)初产妇待宫口完全打开后立即使用腹压,观察组(60例)初产妇待胎头下降至+3 cm时再采用腹压。观察两组产妇分娩方式、第二产程及腹压用时、产妇分娩结局、新生儿状况等。结果两组产妇第二产程用时相较均差异无统计学意义(P>0.05);观察组产妇自然分娩率高于对照组,腹压用时短于对照组(P<0.05);观察组产妇会阴裂伤程度,侧切率以及产后出血少对照组(P<0.05);两组产程中胎心减速情况相较差异无统计学意义(P>0.05);观察组新生儿窒息率为1.66%,低于对照组的13.33%(P<0.05)。结论分娩镇痛的初产妇第二产程中当胎头下降至+3 cm时再采用腹压,可有效提升产妇自然分娩率,缩短腹压用时,改善产妇分娩结局,并可有效降低新生儿窒息率,值得推广。     

导乐分娩在产程中的应用

[目的 ]探讨导乐分娩对分娩方式、产程及母儿的影响 ,从而提高产科质量 ,确保母婴健康。 [方法 ]选择2 0 0例住院分娩的初产妇作为研究对象 ,随机分为导乐组及对照组各 10 0例 ,观察两组产妇的分娩方式、产程时间、产时心理反应、产后 2h出血量及新生儿Apgar 1min评分情况。 [结果 ]导乐组产妇的第一产程、第二产程及总产程均短于对照组 (P <0 .0 1) ;导乐组产妇的剖宫产率、阴道助产率、产后 2h出血量、新生儿窒息发生率及产时不正常心理反应率明显低于对照组 (P <0 .0 1)。 [结论 ]导乐分娩有利于产妇在分娩中保持较好的心理状态和体力 ,调动了产妇主观能动性 ,使产力良好 ,产程缩短 ,避免了不必要的难产和手术产 ,减少了新生儿窒息率和产后出血量 ,提高了产时保健质量。     

体位干预配合长强穴按摩对初产妇分娩效果的研究

目的探讨体位干预配合长强穴按摩对初产妇分娩效果的影响。方法将136例初产妇随机分为两组,观察组71例采用体位干预配合长强穴按摩的方法对初产妇第二产程的进行护理,对照组65例采用常规方法进行护理。分别观察对比两组第二产程时间、阴道流血量及阴道分娩率和新生儿窒息发生率。结果观察组较对照组初产妇的第二产程时间明显缩短(P0.01);产妇产后2h阴道流血量明显减少(P0.01);阴道分娩率高;新生儿窒息率低。结论体位干预配合长强穴按摩能促进第二产程进展,减少产后出血,提高阴道分娩率,降低新生儿窒息率。     

无创阴道接生技术在初产妇阴道分娩中的应用

目的探讨初产妇分娩过程中,无创阴道接生技术的临床应用效果。方法选择232例正常分娩的初产妇随机分为观察组（无创阴道接生技术）和对照组（产妇常规接生技术）,记录2组产妇分娩以及产后出血量、新生儿窒息率及体重,分析并比较2种方法会阴切开情况、裂伤程度以及水肿发生率、第二产程时间和产程中疼痛情况。结果观察组产妇会阴侧切率（39．7％）低于照组（67．2％）,差异有统计学意义（P=0．043）;2组产妇会阴裂伤程度差异有统计学意义（P〈0．05）,但均未出现会阴Ⅲ级裂伤;观察组产妇会阴水肿发生率（17．2％）低于对照组（35．3％）,差异有统计学意义（P=0．041）;观察组产妇疼痛程度显著低于对照组,差异有统计学意义。2组第二产程时间、产时以及产后出血量、新生儿窒息率以及体重差异无统计学意义。结论无创阴道接生技术可降低会阴侧切率,减轻会阴裂伤程度,降低会阴水肿发生率,缓解产妇疼痛症状,提高自然分娩率,临床效果显著,值得推广应用。     

拉梅兹呼吸法结合一对一导乐陪伴分娩在产程中的应用

目的:探讨拉梅兹分娩呼吸法结合导乐陪伴分娩对产程的影响.方法:将在本院孕妇学校上课并在本院产科待产的可行经阴道自然分娩的240例初产妇随机分为观察组与对照组各120例.对照组孕期接受常规的宣教,观察组孕妇除常规宣教外,接受拉梅兹分娩呼吸法训练,并在产程中接受一对一导乐陪伴分娩.结果:与对照组产妇比较,观察组第一产程、第二产程、总产程时间明显缩短(P＜0.01),分娩疼痛明显减轻(P＜0.01),自然分娩率提高(P＜0.01),出血量明显减少(P＜0.0 1).结论:拉梅兹分娩呼吸法结合导乐陪伴分娩可以帮助产妇减轻分娩疼痛,缩短产程,提高自然分娩率,减少产后出血量.     

助产士连续性护理在围产期的应用研究

目的：探讨助产士连续性护理在围产期中的应用效果。方法240例初产妇随机分为观察组和对照组各120例,对照组采用常规护理,观察组采用助产士连续性护理,比较两组产妇的围产期情况。结果观察组第一产程、第二产程和总产程显著短于对照组,差异有统计学意义（ P＜0.05）。观察组阴道分娩率显著高于对照组,产后出血量显著少于对照组,护理满意度显著高于对照组,差异有统计学意义（ P＜0.05）。结论助产士连续性护理能为初产妇围产期提供更为专业的照护,有效缩短产程,提高阴道分娩率。     

腰-硬联合麻醉结合自控镇痛在初产妇分娩镇痛中的应用效果

【目的】探讨腰麻‐硬膜外联合麻醉（CSEA）结合自控镇痛（PCEA）在初产妇分娩镇痛中的应用效果。【方法】选择本院住院待产的足月初产妇996例,根据孕妇及家属意愿分为观察组（ n ＝503）和对照组（ n＝493）。观察组行 CSEA ＋ PCEA 镇痛,对照组常规分娩处理,并采用 PCEA 。观察两组患者镇痛效果、产程进展、缩宫素使用情况、产后出血发生率、羊水Ⅲ度污染率、新生儿窒息发生率、产钳助产率、剖宫产率及不良反应情况。【结果】观察组Ⅰ级和Ⅱ级疼痛比例显著优于对照组,且差异有显著性（ P ＜0．05）;观察组活跃期、第一产程、第二产程时间较对照组均有所延长（ P ＜0．05）;观察组宫缩持续时间较对照组缩短（ P ＜0．05）;两组缩宫素使用率、产后出血发生率、羊水Ⅲ度污染、新生儿窒息发生率、产钳助产率、剖宫产率及不良反应发生率比较差异均无显著性（ P ＞0．05）。【结论】CSEA ＋ PCEA 镇痛效果显著,虽会延长第一产程、第二产程,但对分娩结局无不良影响。     

产程中应用芳香疗法的效果观察

目的探讨产程中应用芳香疗法对分娩结局的影响。方法选择262例单胎、初产妇、头位、足月,排除孕期胎儿窘迫、严重合并症及并发症的初产妇为研究对象。以产妇入院日期的单双号分组,对照组产妇除按常规观察护理外,在宫口开大2~3 cm时予以芳香疗法,对照组按产程观察常规观察护理。比较两组产妇分娩中疼痛程度、产程的时间、产程中用药、分娩方式、新生儿出生体质量、新生儿窒息率及产妇产后出血率。结果观察组疼痛程度低于对照组,差异有统计学意义(P0.01);观察组第一、第二产程及总产程比对照组缩短,差异有统计学意义(P0.01);观察组自然分娩率高于对照组,差异有统计学意义(P0.01);观察组产程中盐酸哌替啶、缩宫素的使用率低于对照组,差异有统计学意义(P0.05或P0.01);两组新生儿出生体质量、新生儿窒息率、产妇产后出血率比较,差异无统计学意义(P0.05)。结论初产妇产程中应用芳香疗法,能有效减轻产妇分娩期疼痛,缩短产程并减少药物的使用,促进自然分娩,降低剖宫产率。     

改良式手-膝位分娩对初产妇分娩结局和舒适度的影响

目的评价第二产程中采用改良式手-膝位分娩对初产妇分娩结局和舒适度的影响。方法选取2019年10月1日—2020年3月31日在西安市某三级甲等医院产房中心分娩的290名初产妇为研究对象,采用随机数字表法分为试验组(n=145)和对照组(n=145),试验组在第二产程采用改良式手-膝位分娩,对照组采用屈膝半卧位分娩,比较两组分娩结局和舒适度的差异。结果试验组自然分娩率高于对照组(χ²=12.590)、会阴侧切率低于对照组(χ²=48.019)、第二产程时间短于对照组(t=-2.579)、产时及产后2 h出血量少于对照组(t=-2.134)、分娩舒适度问卷得分高于对照组(t=-10.775),差异具有统计学意义(均P<0.05);两组新生儿窒息率比较,差异无统计学意义(χ²=0.344,P=0.995)。结论改良式手-膝位分娩可提高产妇自然分娩率,缩短第二产程时间,降低会阴侧切率,减少产后出血,提高产妇分娩舒适度。     

综合干预促进产程进展300例临床观察

目的探讨第一产程采用甘油灌肠、人工破膜、间苯三酚静推联合应用对促进产程进展的影响。方法选择2009年1月至2009年10月住院分娩的初产妇600例,随机分为观察组和对照组,比较两组的宫口开全时间、分娩方式、新生儿窒息及产后出血情况。结果与对照组相比,观察组产妇宫口开全时间缩短,产后出血量减少,剖宫产率、新生儿窒息率明显降低,差异均有统计学意义（P〈0．05～0．01）。结论第一产程中采用甘油灌肠、人工破膜、间苯三酚静推联合应用综合干预可明显缩短产程,促进产程进展,降低剖宫产率,产后出血量及新生儿窒息发生率,提高产科质量。