HELPERR手法主治肩难产效果及预后分析

张璟嵋　赵云燕　曾美云　张荣英

【摘要】 目的：探討四肢着床法（HELPERR）处理肩难产的临床效果及对分娩结局的影响。方法：选择2011年1月-2015年12月本院妇产科分娩中出现的43例肩难产患者进行回顾性分析，其中24例采用HELPERR手法处理（HELPERR组），19例患者采用传统的牵拉胎头、屈大腿和耻骨加压法处理（传统组），对比两组的处理效果及分娩结局。结果：HELPERR组的胎头到胎肩娩出时间显著的低于传统组，比较差异有统计学意义（P<0.05）；两组患者的总产程、第二产程比较差异均无统计学意义（P>0.05）；HELPERR组新生儿平均体重（3361.8±200.3）g与传统组（3334.2±197.5）g比较差异无统计学意义（P>0.05）；HELPERR组的并发症发生率12.50%显著低于传统组42.11%，比较差异有统计学意义（P<0.05）；HELPERR组产妇产后出血发生率4.17%与传统组10.53%比较差异无统计学意义（P>0.05）；HELPERR组的产道裂伤发生率4.17%显著低于传统组26.32%，比较差异有统计学意义（P<0.05）。结论：HELPERR处理肩难产的临床效果优于传统方法，分娩并发症的发生率低。

【关键词】 四肢着床法； 肩难产； 临床效果； 分娩结局

Effect and Prognosis of HELPERR Manipulation on Shoulder/ZHANG Jing-mei，ZHAO Yun-yan，ZENG Mei-yun，et al.//Medical Innovation of China，2017，14（19）：074-077

【Abstract】 Objective：To investigate the clinical effect of the treatment of shoulder difficult labor with the method of the implantation of limbs （HELPERR） and its effect on the outcome of delivery.Method：From January 2011 to December 2015 the hospital department of gynaecology and obstetrics childbirth of 43 cases with shoulder dystocia were retrospectively analyzed，which 24 cases were given helperr handling as HELPERR group；19 cases were treated with traditional pull fetal head，bend thigh and pubic pressure treatment as traditional group，the treatment effects and birth outcomes of two groups were compared.Result：HELPERR group of fetal head to shoulder delivery time was significantly lower than that of the traditional group，the difference was statistically significant（P<0.05）；the total production process and the second labor stage of two groups were not statistically significant（P>0.05）；there was no significant difference of average body weight in HELPERR group （3334.2±197.5）g

and traditional group （3361.8±200.3）g（P>0.05）； the complication rate of HELPERR group was 12.50% significantly lower than that of the traditional group 42.11%，the difference was statistically significant（P<0.05）.HELPERR group of postpartum hemorrhage occurred was 4.17%，the traditional group was 10.53%，the difference was no statistically significant（P>0.05）；the incidence rate of soft birth canal laceration in HELPERR group was 4.17% significantly lower than that of the traditional group 26.32%，the difference was statistically significant（P<0.05）.Conclusion：HELPERR shoulder dystocia clinical treatment is better than the traditional method，and low incidence of birth complications.

【Key words】 HELPERR； Shoulder dystocia； Clinical effect； Birth outcomes

First-authors address：Guicheng Hospital of Nanhai District of Foshan City，Foshan 528200，Chinaendprint

doi：10.3969/j.issn.1674-4985.2017.19.021

肩难产是产科较少见的并发症，国内报道其发生率为0.15%[1]。肩难产是指胎头娩出后，胎儿肩膀卡在骨盆出口处，不能娩出。通常肩难产多发生在巨大儿身上，随着生活的改善，胎儿平均体重的增加，也增加了肩难产的发生率。此外，胎儿经过产道时没有调整到最佳位置，也会引发肩难产。虽然肩难产的发生率不算高，但是一旦发生，对母婴威胁极大，处理不当可造成产妇的产道裂伤，增加产后出血，并导致新生儿锁骨骨折、臂丛神经损傷、窒息等多种严重并发症，甚至导致母婴死亡[2]。目前产科处理肩难产一般采用传统的牵拉胎头、屈大腿和耻骨加压法，但该方法相对延长了胎肩娩出时间，无法有效避免产道损伤及新生儿产伤、窒息的风险[3]。因此……