改良式自然分娩临床路径促进产程进展及产后康复临床研究
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R271

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金华市中医药科技计划项目(金卫〔2022〕117号2023KY39)


Clinical Study on Clinical Pathway of Modified Natural Childbirth in Promoting Labor Progression and Postpartum Rehabilitation
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    摘要:

    目的:观察改良式自然分娩临床路径在经阴道分娩及其产后康复中的效果。方法:选取2023年 1月—2024年3月在义乌市妇幼保健院产科病区住院待产且第一诊断为足月单胎头位自然临产的660例初产妇 作为研究对象,按照随机数字表法分为对照组和观察组各330例。对照组采用常规自然分娩临床路径;观察组 采用改良式自然分娩临床路径,在对照组基础上增加中医适宜技术进行干预,比较2组在加速产程进展和产后 子宫复旧、产后康复的效果。结果:观察组第一产程、第二产程、第三产程、总产程时间均较对照组缩短,差 异有统计学意义(P<0.05)。分娩前,2组疼痛VAS评分比较,差异无统计学意义(P>0.05);分娩30 min及 分娩后,观察组VAS评分均较对照组降低,差异有统计学意义(P<0.05)。产后1、2、3天,观察组子宫底下 降高度均大于对照组,差异均有统计学意义(P<0.05)。产后3天,观察组血性恶露排出量较对照组多,血性 恶露持续时间较对照组缩短,差异均有统计学意义(P<0.05)。产后7天,观察组子宫体大小较对照组缩小, 双侧子宫动脉血流S/D值之和较对照组下降,差异均有统计学意义(P<0.05)。产后42天,观察组宫内组织残 留率为3.33% (11/330),对照组为13.94% (46/330),2组比较,差异有统计学意义(P<0.05)。产后第1、 2、3天,观察组泌乳量均较对照组明显增多,差异均有统计学意义(P<0.05)。观察组会阴切口甲级愈合率为 99.09%(327/330),对照组为94.55%(312/330),2组比较,差异有统计学意义(P<0.05)。观察组会阴切口 平均愈合时间短于对照组,差异有统计学意义(P<0.05)。观察组PSQI量表中睡眠时长大于对照组,睡眠效 率高于对照组,入睡时间短于对照组,睡眠障碍次数少于对照组,日间功能障碍、主观睡眠质量评分均低于对 照组, 差异均有统计学意义(P<0.05)。观察组阴道前后壁膨出发生率为7.88% (26/330), 对照组为 19.39%(64/330),差异有统计学意义(P<0.05);观察组平均盆底肌检测评分高于对照组,差异有统计学意 义(P<0.05)。观察组产后并发症发生率为5.76%(19/330),对照组为30.00%(99/330),2组比较,差异有统 计学意义(P<0.05)。结论:通过中医适宜技术改良自然分娩临床路径可促进产程进展,减轻围产期疼痛,促 进子宫复旧、母乳喂养及会阴切口愈合,改善产妇睡眠质量及盆底肌功能,减少产褥期并发症。

    Abstract:

    Abstract: Objective: To observe the curative effect of the clinical pathway of modified natural childbirth on vaginal delivery and postpartum rehabilitation. Methods: A total of 660 primiparas who were hospitalized in the department of obstetrics of Yiwu Maternity and Children Hospital from January 2023 to March 2024 and were first diagnosed as full-term singleton vertex presentation with spontaneous labor onset were selected as the study subjects and divided into the control group and the observation group according to the random number table method,with 330 cases in each group. The control group was intervented with clinical pathway of conventional natural childbirth; the observation group was intervented with clinical pathway of modified natural childbirth combined with intervention of appropriate Chinese medicine techniques on the basis of the intervention in the control group. The curative effects on accelerating the labor progression,postpartum uterine involution and postpartum rehabilitation were compared between the two groups. Results:The time of the first stage of labor,the second stage of labor,the third stage of labor and the total stage of labor in the observation group were respectively shorter than that in the control group,the difference being significant (P<0.05). Before delivery, there were no significant differences in the comparison of Visual Analogue Scale (VAS) scores of pain between the two groups (P>0.05);thirty minutes after delivery and after delivery,the VAS scores in the observation group were reduced when compared with those in the control group,the difference being significant( P<0.05). One,two and three days after delivery,the height of uterine fundus in the observation group was higher than that in the control group,respectivdy,differences being significant (P<0.05). Three days after delivery, the amount of discharged bloody lochia in the observation group was more than that in the control group, and the duration of bloody lochia was shorter than that in the control group,differences being significant (P<0.05). Seven days after delivery,the uterine body in the observation group was smaller than that in the control group in size,and the sum of S/D value of bilateral uterine artery blood flow was lower than that in the control group, differences being significant (P<0.05). Postpartum follow-up at 42nd day,the residual rate of intrauterine tissue was 3.33% (11/330) in the observation group and 13.94%( 46/330) in the control group,the difference being significant( P<0.05). On the 1st, 2nd and 3rd day after delivery,the lactation volume in the observation group was significantly elevated than that in the control group respectively,the difference being significant (P<0.05). The grade A healing rate of perineal incision was 99.09% (327/330) in the observation group, and 94.55% (312/330) in the control group, the difference being significant (P<0.05). The average healing time of perineal incision in the observation group was shorter than that in the control group, the difference being significant (P<0.05). In the observation group, the sleep duration was longer, sleep efficiency was higher,sleep latency was shorter,sleep disorder was less,and scores of daytime dysfunction and subjective sleep quality in PSQI were lower than those in the control group (P<0.05). The incidence of anterior and posterior vaginal wall prolapse was 7.88% (26/330) in the observation group, and 19.39% (64/330) in the control group,the difference being significant (P<0.05). The average pelvic floor muscle test score in the observation group was higher than that in the control group, the difference being significant (P<0.05). The incidence of postpartum complications was 5.76% (19/330) in the observation group and 30.00% (99/330) in the control group,the difference being significant (P<0.05). Conclusion: The improvements in clinical pathway of natural childbirth by appropriate Chinese medicine technique can promote the labor progression, reduce the perinatal pain, promote the uterine involution,breastfeeding and perineal incision healing,improve the sleep quality and pelvic floor muscle function of primiparas,and reduce the puerperous complications.

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冯玉.改良式自然分娩临床路径促进产程进展及产后康复临床研究[J].新中医,2025,57(12):87-92

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  • 在线发布日期: 2025-06-26
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