Gasbin法配合牵后臂处理肩难产的效果分析

目的 探讨Gasbin法配合牵后臂处理肩难产的效果.方法 选择2014年1月至2016年6月期间西安交通大学医学院第一附属医院妇产采用Gasbin法配合牵后臂助产的肩难产30例作为观察组,同时选择本院2010年1月至2013年12月期间采用常规手法助产的肩难产30例作为对照组,比较两组产妇会阴损伤、产后出血、新生儿娩肩时限、Apgar评分、新生儿窒息及新生儿产伤等母儿结局.结果 观察组和对照组新生儿1min和5min Apgar评分<4分无统计学差异(χ2=2.07,均P>0.05),而观察组和对照组新生儿1min和5min Apgar评分4~7分有统计学差异(χ2=6.24,均P<0.05).观察组新生儿锁骨骨折发生率显著低于对照组(P<0.05),而两组臂丛神经损伤、皮下血肿发生率无显著性差异(均P>0.05).观察组会阴侧切率明显低于对照组(χ2=5.71,P<0.05),且产后出血发生率低于对照组(χ2=4.32,P<0.05).观察组娩肩时限显著短于对照组(t=6.45,P<0.05).结论 在分娩过程中发生肩难产时采用Gasbin法配合牵后臂,可以安全、有效、快速的娩出胎肩,减少产妇会阴侧切率和撕裂伤,降低产后出血的发生率,避免新生儿窒息和新生儿产伤,保障母婴安全.

Effect of Gasbin method combined with pulling upper arm in treating shoulder dystocia

Objective To explore the effect of Gasbin method combined with pulling upper arm in the treatment of shoulder dystocia. Methods From January 2014 to June 2016 totally 30 cases of shoulder dystocia receiving Gasbin method combined with pulling upper arm were selected in observation group from First Affiliated Hospital of Medical College in Xi' an Jiaotong University. Another 30 cases of shoulder dystocia receiving routine method were selected in control group from January 2010 to December 2013 in the hospital. Two groups were compared in terms of maternal perineal injury, postpartum hemorrhage, shoulder delivery time, neonatal Apgar score, neonatal asphyxia and neonatal birth trauma. Results The differences in 1min and 5min Apgar score <4 were not significant between two groups (χ2 =2. 07, both P>0. 05), but there were significant differences in 1min and 5min score 4-7 (χ2 =6. 24, both P<0. 05). Incidence of neonatal clavicular fracture was significantly lower in the observation group than in the control group (P <0. 05), but there was no significant difference in the incidence of brachial plexus injury and subcutaneous hematoma between two groups (both P >0. 05). Episiotomy rate was significantly lower in the observation group (χ2 =5. 71, P<0. 05), and the incidence of postpartum hemorrhage was also lower (χ2 =4. 32, P<0. 05). Shoulder delivery time was significantly shorter in the observation group than in the control group (t=6. 45, P<0. 05). Conclusion Gasbin method combined with pulling upper arm for shoulder dystocia during delivery is safe, effective and rapid in delivery of shoulder. It can reduce maternal episiotomy rate and laceration, reduce the incidence of postpartum hemorrhage, avoid neonatal asphyxia and neonatal injury, and protect maternal and neonatal safety.