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目的回顾分析足月自然产会阴侧切开术和会阴裂伤对产后的影响。方法北京宣武医院2012年1月至12月182例足月孕妇会阴侧切开术92例和会阴裂伤90例,比较伤口出血量和手术时间,切口延伸、愈合率和裂开,伤口肿胀、触痛和硬结,采用视觉模拟评分法(VAS)评估术中、术后疼痛和产痛的比较,产后日常活动对母乳喂养的影响,产后盆底的检查。结果①伤口出血量裂伤组低于侧切组,差异有统计学意义[(33.2±6.0)ml vs(53.2±8.8)ml,P<0.05];缝合时间裂伤组短于侧切组,差异有统计学意义[(13.2±3.0)min vs(16.2±2.2)min,P<0.05];②切口延伸、伤口愈合率和裂开两组差异无统计学意义(P>0.05);产后会阴伤口肿胀(38%vs 22.2%)、触痛(63.8%vs 17.8%)、硬结(53.3%vs 12.2%),会阴侧切组明显高于会阴裂伤组,差异有统计学意义(P<0.01);③侧切组术后疼痛VAS评分比裂伤组高,差异有统计学意义(P<0.05),术中疼痛和产痛两组差异无统计学意义(P>0.05),两组均表现为产痛>术后疼痛>术中疼痛。术后疼痛对产妇影响依次坐、行、排便、睡眠、排尿、翻身活动;④产后母乳喂养会阴侧切组在产后第3天100%母乳喂养,裂伤组产后第2天100%母乳喂养,差异有统计学意义(P<0.05);⑤产后盆底的检查两组比较差异无统计学意义(P>0.05)。结论会阴切开术没有降低损伤的发生,反而增加产后疼痛。
Objective To retrospectively analyze the effects of perineal incision and perineal laceration of full-term natural products on postnatal period. Methods From January 2012 to December 2012, 182 cases of full-term pregnant women with perineal incision and perineal laceration in 182 cases of Xuanwu Hospital from January 2012 to December were analyzed retrospectively. The amount of bleeding and operation time were compared. The incision was extended, the healing rate and cleft, wound swelling, Tenderness and induration. Visual analogue scale (VAS) was used to assess the intraoperative and postoperative pain and pain, the effect of postpartum daily activities on breastfeeding, and the examination of postpartum pelvic floor. Results (1) The amount of hemorrhage in the wound group was lower than that in the group of lateral incision, the difference was statistically significant [(33.2 ± 6.0) ml vs (53.2 ± 8.8) ml, P <0.05] (13.2 ± 3.0) min vs (16.2 ± 2.2) min, P <0.05]. There was no significant difference between the two groups in the extension of incision, wound healing rate and rupture (P> 0.05) (38.3% vs 22.2%), tenderness (63.8% vs 17.8%) and induration (53.3% vs 12.2%). The incidence of episiotomy in the episiotomy group was significantly higher than that in the episiotomy episiotomy group (P <0.01). The VAS score of postoperative pain in the patients in the lateral incision group was higher than that in the laceration group (P <0.05), and there was no significant difference between the two groups (P> 0.05). Both groups showed pain as pain > Postoperative Pain> Intraoperative Pain. Postoperative postpartum breastfeeding episiotomy group 100% breastfeeding on the 3rd postnatal day, 100% breastfeeding on the 2nd day postpartum in the group with laceration, the difference was statistically significant (P <0.05). (5) There was no significant difference in postpartum pelvic examination between the two groups (P> 0.05). Conclusion Perineal incision did not reduce the incidence of injury, but increased postpartum pain.