摘要目的 研究自由体位配合分娩车在第一产程晚期及第二产程的应用效果,选择适宜产妇的分娩体位.方法 选择2015年8—9月在某妇幼保健院产房足月、单胎、头位、自然临产的初产妇208人,在第一产程晚期和第二产程遵循产妇意愿可下床活动,助产士陪同指导产妇辅助分娩车使用自由体位,直至胎头拨露2 cm×2 cm,协助产妇上产床进行常规接生.选取该产房2014年8—9月采取传统的平卧位或半坐卧位待产的初产妇175人作为对照组.比较两组产妇第二产程时间、产时出血量、会阴裂伤或侧切情况、产钳助产情况、新生儿Apgar评分、新生儿出生体重等指标的差异.结果 在第一产程晚期及第二产程初期使用分娩车结合自由体位与传统的卧位或半卧位待产体位相比较,产妇的第二产程时间、产时出血量、分娩时会阴裂伤情况、会阴侧切情况以及产钳助产情况,差异均无统计学意义(P>0.05).使用分娩车结合自由体位后,产妇疼痛自我评分从(8.11±1.59)分减轻为(6.49±1.90)分,差异有统计学意义(t=13.16,P<0.001).结论 在评估胎头固定后的基础上,在第一产程晚期及第二产程直至上台接生采用自由体位辅助分娩车,对产妇是安全的,而且有利于减轻其分娩疼痛感.

abstractsObjective To explore the application effects of free body position with delivery vehicles in the first late stage of labor and the second stage of labor, and to choose a proper delivery position for parturient women.Methods Totally 208 primiparas who had term and spontaneous labor in single pregnancy and head position between August and September 2015 in a maternal and child health hospital were selected and allowed to get out of bed at their will in the first late stage of labor and the second stage of labor. Midwives accompanied and instructed parturient women to use free body position with delivery vehicles, and when head visible on vulval gapping for 2 cm×2 cm, assisted the parturient women for conventional delivery on delivery beds. And 175 primiparas awaiting delivery using traditional horizontal position and fowler position between August and September 2014 were selected as a control group. Then their time of the second stage of labor, intrapartum hemorrhage, perineal laceration or episiotomy, forceps delivery, Apgar scores and body weight of neonates were compared.Results There was no statistical difference in the second stage of labor, intrapartum hemorrhage, perineal episiotomy and forceps delivery between the parturient women using free body position with delivery vehicles and those using traditional horizontal position and fowler position in the first late stage of labor and the second early stage of labor (P>0.05). With the use of free body position with delivery vehicles, the parturient women's VAS was decreased from (8.11±1.59) to (6.49±1.90) (t=13.16,P<0.001).Conclusions Based on the evaluation of engagement, the use of free body position with delivery vehicles in the first late stage of labor until their delivery on bed in the second stage of labor is safe for parturient women and helps to reduce their delivery pain substantially.