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双胎妊娠临床结局分析

【摘要】 目的 探讨双胎妊娠剖宫产指征构成比、临床处理与妊娠结局的关系。 方法 对2000年1月-2009年8月321例双胎妊娠的临床资料进行回顾分析。 结果 ①A组第1胎儿为头位，191例双胎妊娠剖宫产指征首位为社会因素，其次为妊娠并发（合并）症、瘢痕子宫；B组第1胎儿为非头位，65例双胎妊娠剖宫产指征首位为单纯臀位因素（包括肩先露），其次为妊娠并发（合并）症、瘢痕子宫。②平均分娩孕周（36±4）周，剖宫产256例占79.75%， 经阴道分娩65例占20.25%。③剖宫产组新生儿体重≥2 500 g者高于阴道分娩组；两组第1胎儿新生儿窒息率比较无差异，第2胎儿经阴道分娩者新生儿窒息率明显高于剖宫产术者。校正孕周影响后，不同分娩方式间新生儿评分无差异。④lt;33孕周的双胎妊娠以阴道分娩为主，占83.33%；≥33孕周的双胎妊娠剖宫产率明显高于阴道产率。不同分娩方式的产后出血率无差异。 结论 双胎妊娠不是剖宫产的手术指征，孕期须加强监护管理，正确选择双胎妊娠的分娩方式，将有助于降低剖宫产率及新生儿窒息率。

The cognition of intraspinal labor analgesia of women in labor and its influencing factors

Objective To investigate and analyze the cognition of intraspinal labor analgesia (ILA) of women in labor and its influencing factors. Methods A total of 322 women in labor in West China Second University Hospital of Sichuan University between May and September 2015 were investigated by questionnaire, which included the general situation, the pregnancy status, the understanding for labor pain, and the cognition of ILA. Investigator introduced the knowledge of ILA to them after the investigation, and then they were re-investigated for the choice of ILA. Results Only 22.67% of these women in labor knowed ILA clearly, 53.42% heared it but did not understand, and 49.38% liked to use it. The proportion of women in labor who liked to use it increased to 81.89% after introduction, and the difference was significant (P<0.001). Among all factors, the acknowledgement level of ILA and the choice to use it were mainly related to the family awareness concept for labor pain. Conclusions The cognition of ILA of women in labor is not enough, and their using desire is not strong. The family awareness concept is one of the important factors. The education and advertise to the women in labor and their family members after admiting to labor room can increase the choice rate of ILA significantly.

陪护和信息支持对分娩的影响

【摘要】目的 探讨陪护和信息支持对临产孕妇信心、分娩方式及产程的影响。方法 2008年1月-10月住院孕妇84例,在产前由责任护士给予知识宣教,及时提供关于妊娠与分娩的信息支持,协助其放松紧张、恐惧心理,由助产士对临产孕妇进行严密的动态观察。结果 总产程明显缩短,经阴道顺产率明显提高难产率和剖宫产率大大降低。结论 产前产时经责任护士健康教育及心理支持,能增加临产孕妇产前认知,主动配合助产士,缩短产程,降低难产率。

分娩中“痛并快乐着”机制探究及临床应用价值

分娩过程中，绝大部分产妇会有“疼痛、紧张束缚、紧张不安、优柔寡断、神经过敏”及“安逸、轻松、愉快、心满意足、舒适”两种截然相反的情绪情感体验，简言之就是“痛并快乐着”。该文针对这两种情绪体验产生的机制作一简要综述，以便助产士利用该机制为产妇提供支持及帮助，尽量减少产妇的痛苦，从而提高产妇快乐的体验。

New Evidence of The Cochrane Library(Issue 4, 2004)

Local versus Systemic Application of Opioids for Labor Analgesia: A Systematic Review

Objective　To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia. Methods　We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software. Results　A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01). Conclusion　Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.

A Clinical Trial of Low Concentration Ropivacaine Combined with Sulfentanyl Using for Labour Pain

【摘要】目的观察低浓度罗哌卡因复合舒芬太尼用于分娩镇痛的效果。方法2007年5月8月按入选标准选择100例产妇,随机分成试验组和对照组,每组50例。试验组分娩前给予低浓度罗哌卡因加舒芬太尼,对照组不行无痛分娩,通过视觉模拟评分法等指标观察镇痛效果。结果试验组镇痛后视觉模拟评分较对照组低(Plt;0.05);两组镇痛期间血压、心率差异有统计学意义（Plt;0.05），新生儿Apgar评分比较无统计学意义(Pgt;0.05)。结论联合应用罗哌卡因和舒芬太尼用于硬膜外分娩镇痛能取得较好的效果,值得在临床中推广应用。

Comparison of Primiparaes Compliance with Labor Analgesia Based on Educational Background

Objective　To study the special traits of primiparae’s compliance with labor analgesia, so as to offer individualized analgesia solutions during spontaneous labor. Methods　The uniparous primiparae with cephalic presentation between gestational weeks 38 and 40 were divided into two groups based on their educational background (college education or above, and high school education or below), each group with 20 cases. The demographical statistics of the two groups including their State-Trait Anxiety Inventory (STAI) grading, PCA results, and delivery situation were recorded and analyzed. Results　Differences in age, height, and weight were not statisticallysignificant (Pgt;0.05); differences in T-AI were not statistically significant (Pgt;0.05); differences in S-AI were statistically significant (Plt;0.05); differences in anxiety and numbers of adding anesthetics were not statistically significant (Pgt;0.05); differences in failure to tolerate labor pains and requiring caesarean section were statistically significant (Plt;0.05). Conclusion　Primiparae with higher educational degree tend to have higher S-AI grading and perform poorly in compliance with labor analgesia.

罗哌卡因复合芬太尼分娩镇痛的临床观察

目的:观察低浓度罗哌卡因复合芬太尼应用于分娩镇痛的有效性和安全性。方法:选择足月妊娠、头位、单胎、无明显头盆不称,无椎管内硬膜穿刺禁忌且自愿要求分娩镇痛的初产妇60例为观察组,以同期的头位、单胎、无明显头盆不称的初产妇60例作对照组,产程中不用镇痛药。观察两组产妇的镇痛效果(VAS评分)、下肢运动神经阻滞MBS(modified bromage score)产程进展、分娩方式、新生儿Apgar评分、产后出血量。结果:镇痛组产妇镇痛有效率100％,下肢运动神经阻滞轻,宫口扩张速度快、活跃期缩短、剖宫产率低,与对照组比较差异有显著性(Plt;0.05);两组第二、三产程、器械助产率、产后出血量、新生儿Apgar评分均无统计学差异。结论:采用低浓度罗哌卡因复合芬太尼用于分娩镇痛安全、有效,是理想的分娩镇痛方法。

Influence of doula delivery on postpartum depression in puerperae: a meta-analysis

ObjectiveTo systematically review the effect of doula delivery on postpartum depression.MethodsWe searched The Cochrane Library, Web of Science, PubMed, EMbase, CBM, CNKI and WanFang Data databases to collect relevant randomized controlled trials (RCTs) about the effect of doula delivery on postpartum depression from inception to March 24th, 2017. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 19 RCTs involving 10 921 participants were included. The results of meta-analysis showed that the doula delivery could reduce the incidence of postpartum depression (RR=0.36, 95%CI 0.29 to 0.46, P<0.001), and SDS score in doula delivery group was superior to that in the control group (MD=–7.37, 95%CI –11.01 to –3.72, P<0.001).ConclusionThe current evidence shows that doula delivery can reduce the incidence of postpartum depression. Due to the limited quantity and quality of included studies, the above conclusion is still needed to be verified by more high quality studies.