改良应用HELPERR口诀在防治肩难产运用中的效果观察

目的探讨改良应用HELPERR口诀在防治肩难产运用中的效果,为临床防治肩难产提供参考依据。方法收集2008年1月1日-2012年12月31日在来宾市人民医院经阴道分娩的6 015例产妇作为对照组,发生肩难产时未应用HELPERR口诀进行处理; 2012年10-12月对产科医护人员进行全员培训,使全员掌握美国妇产科医师学会推荐的处理肩难产的HELPERR口诀和操作规程;以2013年1月1日-2017年12月31日在该院经阴道分娩的10 025例产妇作为观察组,采用提前应用"HEL"口诀预防具有高危因素的产妇发生肩难产和传统HELPERR口诀处理肩难产,作为观察组1;采用提前应用"HEL"口诀预防具有高危因素的产妇发生肩难产及改良应用"HELPR"口诀处理肩难产,作为观察组2;对研究结果进行分析与比较。结果 (1)观察组肩难产发生率及肩难产所致新生儿窒息、新生儿产伤、新生儿感染、产妇软产道严重撕裂伤、产妇产后出血、产褥感染及肩难产医患纠纷发生率显著低于对照组,差异均有统计学意义(均P<0. 05)。(2)观察组2肩难产所致新生儿窒息、新生儿产伤、新生儿感染、产妇软产道严重撕裂伤、产妇产后出血及产褥感染发生率显著低于观察组1,差异均有统计学意义(均P<0. 05)。结论改良应用HELPERR口诀应用于肩难产的防治中可以降低肩难产的发生率及母婴并发症发生率,减少了肩难产医患纠纷的发生率,更适合运用于没有麻醉师进驻产房的基层医院;定期全员培训可以提高肩难产的防治效果,最终全面提高了产科的医疗质量。

Observation on the application effect of modified HELPERR pithy formula in prevention and treatment of shoulder dystocia

Objective To explore the application effect of modified HELPERR pithy formula in prevention and treatment of shoulder dystocia,provide a reference basis for clinical prevention and treatment of shoulder dystocia. Methods From January 1 st,2008 to December31 st,2012,6 015 pregnant women not treated with HELPERR pithy formula during vaginal delivery in People’s Hospital of Laibin were collected as control group,obstetric medical staff were trained from October to December in 2012,then all the obstetric medical staff mastered HELPERR pithy formula and operating instruction of shoulder dystocia recommended by American College of Obstetricians and Gynecologists. A total of 10 025 women of transvaginal delivery from January 1 st,2013 to December 31 st,2017 were selected as observation group and divided into observation one group( high-risk women,shoulder dystocia was prevented using HEL pithy formula,shoulder dystocia was treated using traditional HELPERR pithy formula) and observation two group( high-risk women,shoulder dystocia was prevented using HEL pithy formula, shoulder dystocia was treated using modified HELPERR pithy formula), the results were analzed and compared.Results The incidence rates of shoulder dystocia,neonatal asphyxia,neonatal birth injury,neonatal infection,severe laceration of soft birth canal,postpartum hemorrhage,puerperal infection,and medical dispute caused by shoulder dystocia in observation group were statistically significantly lower than those in control group( P< 0. 05). The incidence rates of neonatal asphyxia,neonatal birth injury,neonatal infection,severe laceration of soft birth canal,postpartum hemorrhage,and puerperal infection caused by shoulder dystocia in observation two group were statistically significantly lower than those in observation one group( P<0. 05). Conclusion Modified HELPERR pithy formula can reduce the incidence rates of shoulder dystocia,maternal and infantile complications,and medical dispute caused by shoulder dystocia in prevention and treatment of shoulder dystocia,which is suitable for basic hospitals without anesthetists in maternity wards. Regular fullstaff training can improve the prevention and treatment effect of shoulder dystocia and improve the quality of obstetrics.