目的 探讨产时超声管理妊娠期糖尿病产妇产程的应用价值。方法 选择2022年1月1日—2023年12月31日在佛山市高明区人民医院妇产科分娩的妊娠期糖尿病初产妇共100例。患者签署知情同意书后, 按照1∶1比例采用随机数字表法分为对照组和研究组各50例。对照组采用阴道指诊检查判断产程和分娩方式。研究组采用经腹联合会阴超声测量检查判断产程及分娩方式。收集两组初产妇血糖、血常规、分娩方式、产后24 h出血量以及切口情况, 新生儿Apgar评分。结果 研究组阴道分娩率高于对照组（88.0% vs 72.0%, P<0.05）, 而阴道检查次数（4.18±0.8 vs 6.82±0.8, P<0.05）少于对照组、不良事件发生率（4% vs 16%, P<0.05）低于对照组。相对于对照组,研究组血红蛋白水平较高（104.10±5.25 vs 100.30±4.78, P<0.05）、而白细胞计数（11.40±1.49 vs 12.04±1.66, P<0.05）以及中性粒细胞百分比较低（72.79±4.04 vs 75.01±5.53, P<0.05）。结论 通过产时超声监测判断妊娠期糖尿病初产妇产程,能够降低阴道操作引起的感染等风险,提高阴道分娩率,有效降低产妇感染,提高产妇分娩满意度以及舒适度,改善母婴结局。

Objective To explore the application value of intrapartum ultrasound for labor management of pregnant women with gestational diabetes mellitus．Methods A total of 100 primiparous women with gestational diabetes mellitus who gave birth in the Obstetrics and Gynecology Department of Foshan Gaoming District People’s Hospital from January 1, 2022 to December 31, 2023 were selected．After signing the informed consent form, the patients were randomly divided into a control group and a study group with 50 cases in each group according to a ratio of 1∶1, using a random number table method．The control group underwent vaginal digital examination to assess the labor process and delivery method．For the study group, the labor process and delivery mode were determined using transabdominal ultrasound measurement．Blood glucose level,routine blood test results, delivery methods, 24-hour postpartum bleeding volume and incision conditions of two groups of primiparas, as well as the Apgar score of newborns were collected．Results The study group demonstrated a significantly higher vaginal delivery rate than the control group（88.0% vs 72.0%, P<0.05）, with fewer vaginal examinations（4.18±0.80 vs 6.82±0.80, P<0.05）and a lower incidence of adverse events（4% vs 16%, P<0.05）．Compared to the control group, the study group exhibited higher hemoglobin levels（[104.10±5.25]g/L vs [100.30±4.78] g/L, P<0.05）, but lower white blood cell counts（[11.40±1.49]×109/L vs [12.04±1.66]×109/L, P<0.05）and reduced neutrophil percentages（[72.79±4.04]% vs [75.01±5.53]%, P<0.05）．Conclusions Intrapartum ultrasound monitoring for assessing labor progression in primiparas with gestational diabetes mellitus reduces infection risks associated with vaginal procedures, increases vaginal delivery rates, effectively decreases maternal infections, enhances maternal satisfaction and comfort during delivery,and improves maternal-neonatal outcomes．

目的 分析多元化团体互动健康教育在初产妇女围产期的应用效果。方法 选取2019年6月—2021年6月在我院顺利分娩的168例孕产妇为研究对象,采用随机数字表法分为观察组和对照组,各组均84例,2组围产期均给予常规健康教育,观察组同时给予多元化团体互动健康教育,比较2组的应用效果。结果 观察组孕产妇的各产程和住院时间均短于对照组;观察组产褥期后母亲角色适应情况优于对照组;产后1周和产后1个月较干预前2组的母乳喂养自信量表评分均升高,且观察组较高;干预后较干预前2组的焦虑自评量表和抑郁自评量表评分均降低,且观察组较低;观察组的子宫复旧、恶露量及便秘、尿潴留、切口感染发生率均低于对照组,差异有统计学意义(P＜0.05)。结论 初产妇女围产期给予多元化团体互动健康教育能够帮助其促进产后恢复,较快适应母亲角色,提高母乳喂养能力,缓解负性情绪,降低不良反应。

Objective To analyze the effect of diversified group interactive health education on perinatal period of primiparous women. Methods A total of 168 women who gave birth successfully in our hospital from June 2019 to June 2021 were selected as the research objects, and divided into an observation group and a control group by random number table method, with 84 cases in each group.Both groups were given routine health education during perinatal period, and the observation group was given diversified group interactive health education additionally, the effects of the two groups were compared. Results The duration of labor and hospital stay were shorter in the observation group than in the control group.The maternal role adaptation of observation group was better than control group after puerperium.The Breastfeeding Self-Efficacy Scale scores of 1 week postpartum and 1 month postpartum were higher than those of the two groups before intervention, and the observation group was higher.After intervention, Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of the observation group were lower than those before intervention, and the observation group was lower.Uterine involution, lochia volume, incidence of constipation, urinary retention and incision infection rate in the observation group were lower than those in the control group, and the differences were significant (P<0.05). Conclusions Primiparous women given diversified group interactive health education during the perinatal period can help them to promote postpartum recovery, adapt to being a mother quickly, improve breastfeeding ability, relieve negative emotions, and reduce adverse reactions.

目的 探讨腰-硬联合阻滞分娩镇痛方式对初产妇在产程进展及产时发热的影响,为临床实践提供理论依据。方法 回顾性分析2020年12月—2021年12月在广州市某三甲医院产科分娩产妇535例的基本资料。观察组（285例）采用腰-硬联合阻滞麻醉分娩镇痛,对照组（250例）选择常规无干预分娩。结果 观察组中的产妇第一产程和第二产程的时间比对照组更长,且产后2 h出血量高于对照组,差异有统计学意义（P<0.05）,除此之外,2组产妇产时发热率比较差异也有统计学意义（P<0.01）。结论 腰硬联合阻滞分娩镇痛在一定程度上会延长产程,且产后2 h的出血量较多,同时也会增加产时发热的概率,存在一定不良反应,故需要密切观察,保证母儿安全。

Objective To investigate the effect of combined spinal-epidural block anesthesia on the progress of labor and intrapartum fever in primipara,and to provide a theoretical basis for clinical practice．Methods The basic data of 535 pregnant women who gave birth in the obstetrics department of a tertiary hospital in Guangzhou from December 2020 to December 2021 were retrospectively analyzed．The observation group（285 cases）was given labor analgesia,and the control group（250 cases）was given routine non-intervention delivery．Results The time of the first stage of labor and the second stage of labor in the observation group was significantly longer than that in the control group,and the bleeding volume 2 hours after delivery was higher than that in the control group,and the difference was statistically significant（P<0.05）．The maternal fever rate during delivery also had statistical significance（P<0.01）．Conclusions Combined spinal-epidural block anesthesia will prolong the labor process to a certain extent,and the amount of bleeding in 2 hours after delivery will be more,and it will also increase the probability of intrapartum fever,with certain adverse reactions．Therefore,close observation is needed to ensure the mother and child safety．

目的 观察父亲参与的早期母婴皮肤接触(SSC)对顺产初产妇的新生儿应激反应及生命体征的影响,为进一步优化“新生儿早期基本保健(EENC)”技术的临床实施建议提供实验依据。方法 使用随机数字表选取2017年2月—2021年5月期间,在深圳市福田区妇幼保健院产科分娩的1 986例顺产初产妇及新生儿作为研究对象。其中638例新生儿(共同参与组)实施了父亲参与的早期SSC,467例新生儿(SSC组)实施了早期母婴SSC,881例新生儿(对照组)实施了常规新生儿处理。观察3组新生儿的唾液皮质醇水平、体温和低温发生率、心率以及啼哭时间的差异,探讨父亲参与的早期母婴SSC在临床实施的可行性。结果 ① 3组新生儿出生30 min、60 min、90 min、180 min时,任意2组唾液皮质醇水平比较,差异均有统计学意义(均P<0.01);出生120 min时,共同参与组与对照组、SSC组与对照组比较,差异均有统计学意义(均P<0.01)。② 3组新生儿出生30 min、60 min时,共同参与组与对照组,SSC组与对照组的体温、低温发生率比较,差异均有统计学意义(均P<0.01);出生90 min时,任意2组体温比较,差异均有统计学意义(均P<0.01),共同参与组与对照组,SSC组与对照组的低温发生率比较,差异均有统计学意义(均P<0.01);出生120 min、180 min时,任意2组的体温与低温发生率比较,差异均有统计学意义(均P<0.01)。③ 3组新生儿出生30 min、60 min、90 min时,共同参与组与对照组,SSC组与对照组的心率比较,差异均有统计学意义(均P<0.01)。出生120 min、180 min时,任意2组比较,差异均有统计学意义(均P<0.01)。④ 3组新生儿出生0～30 min、30～60 min、60～90 min时间段,共同参与组与对照组,SSC组与对照组的啼哭时间比较,差异均有统计学意义(均P<0.01)。出生90～120 min、120～180 min时间段:任意2组的啼哭时间比较,差异均有统计学意义(均P<0.01)。结论 早期母婴SSC和父亲参与的早期母婴SSC均能降低顺产初产妇的新生儿唾液皮质醇水平,维持恒定的体温和心率,减少低温发生率和啼哭时间。相比较而言,父亲参与的早期母婴SSC是一种更科学、更有利于降低新生儿应激反应及维护其生命体征的护理模式。

Objective To observe the effect of father's participation in early maternal skin to skin contact (SSC) on primiparas' neonatal stress response and vital signs, so as to provide experimental basis for further optimizing the clinical implementation of “early essential newborn care (EENC)” technology. Methods The random number table was used to select 1 986 primiparas with their newborns who gave birth in Shenzhen Futian District Maternity and Child Healthcare Hospital from February 2017 to may 2021. Among them, 638 newborns (co-participation group) implemented early SSC with father participation, 467 newborns (SSC group) implemented early maternal and infant SSC, 881 newborns (control group) were treated with routine neonatal treatment. To observe the differences of salivary cortisol level, mean body temperature, incidence of hypothermia, heart rate and crying time among the newborns of three groups and to explore the feasibility of early mother and infant SSC with father participation in clinical implementation. Results ①There were significant differences in newborn salivary cortisol levels between any two groups at 30 min, 60 min, 90 min and 180 min after birth (all P<0.01). At 120 min after birth, there were significant differences between the co-participation group and the control group, SSC group and the control group (all P<0.01). ②At 30 min and 60 min after birth, there were significant differences in body temperature and the incidence of hypothermia between the co-participation group and the control group, SSC group and the control group (all P<0.01). At 90 min after birth, there were significant differences in body temperature between any two groups (all P<0.01). There were significant differences in the incidence of hypothermia between the co-participation group and the control group, SSC group and the control group (all P<0.01). There were significant differences in body temperature and the incidence of hypothermia between any two groups at 120 min and 180 min (all P<0.01). ③At 30 min, 60 min and 90 min after birth, there were significant differences in heart rate between the co-participation group and the control group, SSC group and the control group (all P<0.01). At 120 min and 180 min after birth, there were significant differences between any two groups (all P<0.01). ④There were significant differences in the crying time of newborns in the three groups at 0-30 min, 30-60 min and 60-90 min, between the co-participation group and the control group, and between the SSC group and control group (all P<0.01). There were significant differences in crying time between any two groups at 90-120 min and 120-180 min after birth (all P<0.01). Conclusions Early maternal and infant SSC and early maternal and infant SSC participated by father could reduce the salivary cortisol level of primipara newborn, maintain constant body temperature and heart rate,also reduce the incidence of hypothermia and crying time. In comparison, the early maternal and infant SSC with father participation was a more scientific and conducive nursing model to reduce neonatal stress response and maintain their vital signs.

目的 探讨双侧会阴神经阻滞麻醉配合综合护理在降低单胎初产妇顺产会阴侧切率中的应用效果。方法 选取2019年7月—2019年12月在我院经阴道分娩的顺产初产妇110例为研究对象,按照随机数字表法分成两组,每组各55例,所选产妇对照组产妇给予常规护理模式,给予局部浸润麻,观察组产妇在对照组基础上采用综合护理模式,给予双侧会阴神经阻滞麻醉,比较两组产妇会阴侧切情况、会阴裂伤情况、产程持续时间、VAS评分、新生儿Apgar评分、依从性情况及护理效果等相关指标。结果 和对照组相比,观察组患者会阴侧切发生率少于对照组(P＜0.05),第一、第二产程时间短于对照组(P＜0.05);同对照组相比,观察组产妇在VAS评分、依从性及满意度指标均优于对照组(P＜0.05),而新生儿窒息、产后出血发生情况比较差异无统计学意义(P＞0.05)。结论 双侧会阴神经阻滞麻醉配合综合护理可以有效降低初产妇会阴侧切的发生率,减轻分娩时的疼痛,缩短产程,提高产妇依从性及满意度,具有较高的临床推广价值。

Objective To explore the effect of bilateral perineum nerve block anesthesia combined with comprehensive nursing in reducing the rate of perineum side cutting of primipara. Methods 110 primiparas who delivered vaginally in our hospital from July 2019 to December 2019 were selected as the research objects. According to the random number table method, they were divided into two groups, 55 in each group. The control group was given the routine nursing mode and local infiltration anesthesia. The observation group was given the comprehensive nursing mode and bilateral perineum nerve block anesthesia on the basis of the control group. The perineum side cutting status, perineum laceration, duration of labor, VAS score, Apgar score, compliance and nursing effect of the two groups were compared. Results Compared with the control group, the incidence of perineum side cutting was lower in the observation group than that in the control group (P<0.05).The first and second stages of labor were shorter in the observation group than the control group (P<0.05); compared with the control group, the VAS score, compliance and satisfaction index were better in the observation group than the control group (P<0.05), but there was no significant difference in neonatal asphyxia and postpartum hemorrhage (P>0.05). Conclusion Bilateral perineum nerve block anesthesia combined with comprehensive nursing may effectively reduce the incidence of perineum lateral incision of primipara, reduce the pain during delivery, shorten the labor process, improve the compliance and satisfaction of parturients, and has a high clinical value.