"安全分娩核查表"对产妇应激、自然分娩妊娠结局的影响

谢卫苹　　吴朝勇　　李盈盈

[摘要] 目的 探討“安全分娩核查表”对产妇应激、自然分娩妊娠结局的影响。 方法 选择2019年9月至2020年8月在我院自然分娩的孕产妇60例为研究对象，随机分为观察组与对照组，每组各30例。对照组采用常规入院待产干预，观察组在此基础上采用“安全分娩核查表”干预。比较两组不同时间点焦虑评分、血浆去甲肾上腺素（NE）、促肾上腺皮质激素（ACTH）、皮质醇（COR）水平、妊娠结局、满意度。 结果 （1）待产前，两组焦虑评分较入院时均有显著升高，差异有统计学意义（P<0.05）;分娩后4 h，两组产妇焦虑评分有所下降。但待产前、分娩后4 h对照组焦虑评分均显著高于观察组，差异有统计学意义（P<0.05）。（2）两组待产前NE、ACTH、COR水平较入院时均显著升高，差异有统计学意义（P<0.05）;分娩后NE、ACTH、COR水平较待产前均显著下降，差异有统计学意义（P<0.05）;待产前、分娩后观察组NE、ACTH、COR水平均显著低于对照组，差异有统计学意义（P<0.05）。（3）观察组第二产程延长发生率、产后出血发生率显著低于对照组，差异有统计学意义（P<0.05）;观察组胎儿窘迫发生率、新生儿窒息发生率均低于对照组，但差异无统计学意义（P>0.05）。（4）观察组出院时满意度优于对照组，差异有统计学意义（P<0.05）。 结论 “安全分娩核查表”可显著缓解产妇应激反应、焦虑情绪，改善自然分娩妊娠结局。

[关键词] “安全分娩核查表”;应激;自然分娩;妊娠结局

[中图分类号] R714.3          [文献标识码] B          [文章编号] 1673-9701（2021）09-0082-04

Effect of "Safe Childbirth Checklist" on maternal stress and outcome of natural delivery

XIE Weiping   WU Chaoyong   LI Yingying

Department of Gynecology and Obstetrics，Keqiao District Women and Children′s Hospital of Shaoxing City in Zhejiang Province，Shaoxing   312030，China

[Abstract] Objective To explore the effect of "safe childbirth checklist" on maternal stress and outcome of natural delivery. Methods A total of 60 cases of pregnant women who gave birth naturally in our hospital from September 2019 to August 2020 were selected as the study subjects， and they were randomly divided into observation group and control group，with 30 cases in each group. The control group was given routine hospital admissions for labor intervention. On this basis，the observation group was further given the "safe childbirth checklist" intervention. The anxiety scores，plasma norepinephrine， adrenoeorticotropic hormone， cortisol levels， pregnancy outcome， and satisfaction were compared between the two groups at different time points. Results （1） Before delivery， the anxiety scores between the two groups were significantly increased， which was significantly different from those upon admission （P<0.05）; at 4 h after delivery， the anxiety scores in both groups were decreased. However， the anxiety scores in the control group were significantly higher than those in the observation group before delivery and 4 h after delivery （P<0.05）. （2） The levels of norepinephrine， adrenoeorticotropic hormone，and cortisol between the two groups were significantly increased before delivery，and the difference was statistically significant compared with those upon admission（P<0.05）; the levels of norepinephrine， adrenoeorticotropic hormone，and cortisol were decreased significantly after delivery， which were significantly different from those before delivery（P<0.05）; before delivery and after delivery，the levels of norepinephrine， adrenoeorticotropic hormone， and cortisol in the observation group were significantly lower than those in the control group， and the differences were statistically significant （P<0.05）. （3） The incidence rate of prolonged second stage of labor and the incidence rate of postpartum hemorrhage in the observation group were significantly lower than those in the control group（P<0.05）; the incidence rate of fetal distress and neonatal asphyxia in the observation group were lower than those in the control group，but the difference was not statistically significant（P>0.05）. （4）The satisfaction degree in the observation group at discharge was better than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion The "safe childbirth checklist" can significantly alleviate maternal stress and anxiety， and improve the outcome of natural childbirth.

[Key words] "Safe childbirth checklist"; Stress; Natural delivery; Delivery outcomes

据统计，2013年全世界范围内有289 000名孕产妇在妊娠期及围分娩期死亡，280万名新生儿在出生后28 d内死亡[1]。绝大多数孕产妇和新生儿死亡原因是可以预防的。分娩过程十分复杂，应采用一切可能的措施保障母婴安全。WHO提出的“安全分娩核查表”[2]將复杂的分娩过程系统化，以确保分娩过程更安全。分娩过程中产妇的生理、心理均会发生巨大的变化，需在较短的时间内进行较大的调整。分娩对于孕产妇来说是一个应激源，产妇在围生期会出现不同程度的应激反应，而这些应激反应会引起情绪波动、免疫系统功能紊乱、水电解质失衡、内环境紊乱，影响子宫收缩减少，产程延长，增加围生期不良结局的风险[3-4]。目前WHO提出的“安全分娩核查表”广泛应用于临床工作中。有报道显示，其可以有效减少围生期不良情况的发生，提高分娩安全性。……