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目的探讨水中分娩保护会阴的意义。并对保护会阴的手法进行对比,评价实际效果。方法上海市长宁区妇幼保健院2003年3月至2010年5月总计2963例水中分娩病例中符合入选标准者共1991例,以不保护会阴、简单手法保护会阴、单手法保护会阴作为分组依据分为观察组、对照组、保护组3组。结果观察组1055例,其中会阴无裂伤、Ⅰ、Ⅱ、Ⅲ度裂伤分别为35、439、568、5例,行会阴切开术8例;对照组804例,其中会阴无裂伤、Ⅰ、Ⅱ、Ⅲ度裂伤分别为18、305、472、3例,行会阴切开术6例;保护组132例,会阴无裂伤、Ⅰ、Ⅱ、Ⅲ度裂伤分别为7、94、31、0例,无行会阴切开术者。采用多组单向有序分类资料的Ridit分析方法和采用SNK法进行两两比较。结果显示F=31.036,P<0.001,3组产妇会阴裂伤程度差异有统计学意义。两两比较结果保护组平均秩次显著低于其他两组,有统计学意义,观察组平均秩次亦低于对照组,但差异无统计学意义。结论水中分娩保护会阴是必要的。单手法保护会阴会阴Ⅰ度裂伤率明显高于其他两组,Ⅱ度裂伤率明显低于其他两组,无Ⅲ度裂伤发生。可有效防止会阴的严重裂伤。
Objective To explore the significance of water birth protection perineum. And to protect the perineal practices compared to evaluate the actual results. Methods Changning District Maternity and Child Care Hospital in Shanghai from March 2003 to May 2010 a total of 2963 cases of childbirth in water meet the inclusion criteria were a total of 1991 cases to not protect the perineum, simple way to protect the perineum, single-hand protection of the perineum as a basis for grouping For the observation group, control group, protection group 3 groups. Results The observation group of 1055 cases, including perineal no laceration, Ⅰ, Ⅱ, Ⅲ degree laceration were 35,439,568,5 cases, perineal incision in 8 cases; control group of 804 cases, including perineal no laceration, There were 18,305,472 cases of laceration in grade Ⅰ, Ⅱ, and Ⅲ, 6 cases of perineal incision, 132 cases of protection group, no perineal laceration, and laceration of grade Ⅰ, Ⅱ and Ⅲ were 7,94 , 31,0 cases, no line of perineal incision. Ridit analysis using multiple sets of one-way ordinal classification data and SNK method were used for comparison. The results showed that F = 31.036, P <0.001, 3 groups have significant differences in the degree of perineal laceration. The results showed that the mean rank of protection group was significantly lower than the other two groups, with statistical significance. The mean rank of observation group was also lower than that of control group, but the difference was not statistically significant. Conclusion Water delivery protects the perineum is necessary. One-hand method to protect perineal perineum Ⅰ degree laceration rate was significantly higher than the other two groups, Ⅱ degree laceration rate was significantly lower than the other two groups, no degree Ⅲ laceration. Can effectively prevent severe perineal laceration.