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川崎前锋对浦和红钻:全程陪伴式導樂分娩對分娩結局的影響

時間:2019-08-07 來源:未知 作者:依依 本文字數:5075字

浦和红钻超清壁纸 www.ksbedr.com.cn   摘 要

  目的

  通過對某三甲醫院收治孕產婦的分娩過程進行護理干預,調查在產科服務中引入全程陪伴式導樂分娩(Doula on whole process-accompanied delivery)這一方式對產婦產程進展、疼痛感受、心理狀態、分娩結局、產后抑郁、護理滿意度等方面的影響,并針對其中的相關因素進行分析。探討全程陪伴式導樂在分娩全程的應用效果與意義,為提高自然分娩率、優化分娩模式提供參考依據。

  方法以某三甲醫院婦產科 2016 年 7 月至 2018 年 7 月期間收治的孕產婦 1831 例為研究對象,通過自制問卷、產程記錄、產后回訪等方式進行調查和資料收集,根據其自愿選擇進行分組,其中知情同意且按全程陪伴式導樂干預流程處理的歸為干預組;未進行導樂干預常規分娩流程處理的歸為非干預組。比較兩組產婦的分娩過程、分娩結局、產后心理等方面有何差異。所收集記錄數據和資料按分組進行對比分析,SPSS 22.0 及 SAS 9.1 統計學軟件進行分析,采用 n 或%反映計數資料,計數資料比較用χ檢驗,等級資料比較用行平均得分差檢驗。

  結果

  1. 分娩態度:分娩前干預組有 221 人(39.25%)對分娩從不感到害怕,有316 人(56.13%)對分娩輕度緊張、但尚未恐懼,有 15 人(2.67%)感覺即將分娩已造成了一定的煩擾,有 11 人(1.95%)感到十分擔心、已影響到自身健康;非干預組有 988 人(77.92%)對分娩從不感到害怕、有 244 人(19.24%)對分娩輕度緊張、但尚未恐懼,有 25 人(1.97%)感覺即將分娩已造成了一定的煩擾,有 11 人(0.87%)感到十分擔心、已影響到自身健康。

  2. 心理狀態:產后 48h 測評,干預組中度焦慮人數由 125 人(22.20%)降至 116 人(20.61%),重度焦慮人數由 22 人(3.91%)降至 13 人(2.31%);非干預組中度焦慮人數由 318 人(25.08%)降至 299 人(23.58%),重度焦慮人數由 84 人(6.62%)升至 91 人(7.18%)。

  3. 分娩疼痛:干預組評分為優(0~2 分)的有 155 例(27.53%),評分為差(>8 分)的有 39 例(6.93%);非干預組有 373 例(29.42%)評分為優(0~2 分)、118 例(9.31%)評分為差(>8 分)。

  4. 分娩結局:干預組有 81 例(14.39%)最終轉為剖宮產,其中中轉剖 35例(6.21%),計劃外干預 46 例(8.17%),非干預組共有 253 例(19.95%)最終轉為剖宮產,其中中轉剖 146 例(11.51%),計劃外干預 107 例(8.44%)。

  5. 干預組產婦產后出血例數 28 例少于非干預組 85 例、新生兒 Apgar 評分不滿 10 分者 32 例少于非干預組 113 例。干預組尿潴留發生例數 11 例少于非干預組 48 例。

  6. 產后抑郁:干預組評分等于或低于 9 分者 289 例(51.33%),非干預組為 565 例(25.2%);干預組評分等于或高于 13 分者可進行綜合干預的產婦有61 例(10.83%),非干預組為 245 例(13.38%)。

  結論

  1. 干預組的孕產婦在臨產前對分娩的緊張、恐懼程度要明顯低于非干預組,良好的心態對促進自然分娩、保證產程順利進行有積極作用。

  2. 在整個產程的不同階段,應用不同的方式(合理體位、導樂球、音樂、導樂儀等)對產婦進行全程陪伴式的干預,能夠影響產婦的分娩過程:表現在緩解產婦分娩焦慮、提高自然分娩率、減少產后并發癥、減輕產后抑郁等方面。

  這與導樂師在產婦分娩時給予的全程陪伴、對產婦心理生理感受的高度關注以及科學、有效的干預和疏導等有關。

  3. 全程陪伴式導樂分娩有效改善了產婦的分娩感受、促進了產婦的分娩舒適度,這對提高自然分娩率、降低剖宮產率、促進產婦良好預后、保證母嬰健康等有積極作用,對提升產科服務質量有臨床指導意義。

  關鍵詞: 全程陪伴;導樂;分娩

護理碩士論文

  Abstract

  Objectives

  Through nursing intervention in the delivery process of pregnant womenadmitted to a third class hospital, the authors investigated the effect of (Doula onwhole process-accompanied delivery) on the progress, pain and psychological state ofdelivery. The effects of childbirth outcome, postpartum depression and nursingsatisfaction were analyzed. To explore the effect and significance of the application ofDoula in the whole course of labor, to provide reference for improving the rate ofnatural delivery and optimizing the mode of delivery.

  MethodsFrom July 2016 to July 2018, 1831 cases of pregnant and lying-in womenadmitted to gynecology and obstetrics department from July 2016 to July 2018 wereselected for investigation and data collection through self-made questionnaires,records of labor process and postpartum visits, and were grouped according to theirvoluntary choices. Informed consent and according to the whole process ofaccompanying Doula intervention process were classified as the intervention group;Those without Doula intervention were classified as non-intervention group. Thedifferences of delivery process, delivery outcome and postpartum psychologybetween the two groups were compared. Recorded data and data collected forcomparative analysis by group, SPSS 22.0 and SAS 9 .1 Statistical software was usedto analyze, n or% reflection counting data, count data comparison usingResults.

  1. Delivery attitude: 221 people (39.25%) in the pre-delivery intervention groupwere never afraid of delivery, 316 (56.13%) were slightly nervous about delivery, butnot yet afraid. Fifteen (2.67 per cent) felt that the imminent delivery had caused someannoyance, while 11 (1.95 per cent) were very worried and had affected their ownhealth; In the non-intervention group, 988 (77.92%) were never afraid of childbirth,244 (19.24%) were slightly nervous about delivery, but not yet frightened, and 25(1.97%) felt that the impending delivery had caused some disturbance, with 11 cases.People (0.87%) are very worried and have affected their own health.

  2. Psychological status: the number of moderate anxiety in intervention groupdecreased from 125 (22.20%) to 116 (20.61%), and the number of severe anxietydecreased from 22 (3.91%) to 13 (2.31%) in 48 hours postpartum. In thenon-intervention group, the number of moderate anxiety decreased from 318 (25.08%)to 299 (23.58%), and the number of severe anxiety increased from 84 (6.62%) to 91(7.18%).

  3. There were 155 cases (27.53%) with excellent score (0~2 points) and 39cases (6.93%) with poor score (> 8points) in the intervention group. In thenon-intervention group, 373 cases (29.42%) had excellent scores (0~2 points) and118 cases (9.31%) had poor scores (> 8 points).

  4. Delivery outcome: 81 cases (14.39%) in the intervention group wereconverted to cesarean section, 35 cases (6.21%) were converted to cesarean section,46 cases (8.17%) were unplanned intervention, 253 cases (19.95%) in thenon-intervention group were finally converted to cesarean section. Among them, 146cases (11.51%) were transferred to dissection, 107 cases (8.44%) were unplannedintervention.

  5. The number of postpartum hemorrhage in intervention group (28 cases) wasless than that in non-intervention group (85 cases), and the number of neonatal Apgarscore less than 10 cases (32 cases) was less than that in non-intervention group (113cases). The incidence of urinary retention in the intervention group was less than thatin the non-intervention group.

  6. Postpartum depression: 289 cases (51.33%) in intervention group and 565cases (25.2%) in non-intervention group; There were 61 cases (10.83%) inintervention group and 245 cases (13.38%) in non-intervention group..

  Conclusion

  1. The pregnant and lying-in women in the intervention group had lower degreeof fear than that in the non-intervention group before labor, and a good state of mindplayed a positive role in promoting the natural delivery and ensuring the smooth progress of labor.

  2. At different stages of labor, the use of different ways (reasonable posture, ball,music, instrument, etc.) in the whole period of labor can influence the deliveryprocess of the parturient: it can alleviate the anxiety of the parturient. Improve therate of natural delivery, reduce postpartum complications, reduce postpartumdepression and so on. This has something to do with the full companionship, theattention to the psychophysiological feelings of the parturient, the science, theeffective intervention and the guidance.

  3. Doula can effectively improve the feeling of delivery and promote thecomfort of delivery, which can improve the rate of natural delivery, reduce the rate ofcesarean section, promote the good prognosis of parturient and ensure the health ofmother and child. It is of clinical significance to improve the quality of obstetricalservice.

  Key words: Complete companionship; Doula; Delivery.

  目錄

  1 引言

  1.1 研究背景

  自剖宮產技術產生以來,隨著社會環境的變化和社會醫學衛生技術的不斷提升,有很多的孕產婦因為害怕分娩疼痛,擔心順產對身體的影響等而選擇了剖宮產方式分娩。雖然這一方式可以一定程度上避免自然分娩產程中漫長的等待,也解決很多難產問題,在非常情況下對母嬰的搶救效果相對顯著,但一些實踐表明,剖宮產方式分娩的胎兒由于沒有經歷產道的擠壓對嬰兒肺部的刺激等,后期對胎兒的肺部發育會有一定的影響。而且,剖宮產跟產婦的乳汁分泌率降低、術后子宮復舊、傷口愈合等有關,一定程度上影響了產婦的盡快恢復,不利于新生兒的健康成長??悸塹階勻環置潿蘊ザ⒂?、產婦身體情況的有利作用,以及自然分娩后產婦較快恢復的優勢,進一步采取有效的方式和干預方法,去幫助產婦自然分娩并有效縮減產程,對確保母嬰健康安全具有重要意義。

  近年來由于各種原因導致無指征性剖宮產率居高不下,降低剖宮產率、適應新的產時模式、降低側切率、提高自然分娩率成為了各大醫院婦產科工作中的一個極大的挑戰。我國剖宮產率一直居高不下,受到了社會的廣泛關注和有關部門的高度重視,這是一個非常嚴重的“公共衛生問題”。

  現代社會背景下,從獨生子女政策到如今的二胎政策,所見到的是每一位孩子對于每一個家庭的彌足珍貴,孕產婦及其家庭從備孕期就開始充分準備,越來越多的家庭關注到孕產婦的圍產保健、產科醫院的選擇、產后恢復、新生兒照護及喂養等方方面面的問題。在注重人文關懷的現代醫學背景下,如何創新助產醫學模式從而進一步改善產婦對自然分娩的感知感受,顯得更為重要。

  全程陪伴式導樂分娩即由導樂人員(一般是由助產專業的醫護人員來承擔)對孕產婦進行“一對一”的陪伴并直至其分娩的全過程,在此過程中導樂師對孕產婦從生理、心理、情感等多方面予以綜合全面的支持和干預,最終幫助產婦建立自然分娩的信心,鼓勵產婦勇敢面對分娩這一生理現象并能積極面對。經過近幾年的推廣及發展,全程陪伴式導樂分娩這種體現現代產科人文關懷的醫療模式進入分娩服務領域。全程陪伴式導樂分娩是產科高端服務中的一種,作為新型的助產模式在推廣后受到許多孕產婦及其家庭的關注和青睞。

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  1.2 研究目的和意義

  2 對象與方法

  2.1 調查對象
  2.2 方法
  2.2.1 調查方法
  2.2.2 調查內容
  2.2.3 流程圖
  2.2.4 質量控制
  2.2.5 統計方法

  3 結果

  3.1 調查研究對象的基本情況
  3.2 分娩態度差異比較
  3.3 全程陪伴式導樂分娩對分娩過程及分娩結局的影響
  3.3.1 導樂對產婦分娩焦慮的影響
  3.3.2 導樂對產婦分娩疼痛的影響
  3.3.3 導樂對產婦分娩結局的影響
  3.3.4 導樂對產婦產后抑郁的影響

  4 討論

  4.1 調查研究對象的基本情況
  4.2 分娩態度與導樂意向的相關性
  4.3 導樂干預對孕產婦焦慮、疼痛的影響
  4.4 導樂干預對孕產婦分娩結局的影響
  4.5 導樂干預對孕產婦產后抑郁的影響

  5 結論

  參考文獻

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