阴道分娩产妇分娩期全流程护理方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2025.01.001

摘要/Abstract

摘要：

目的构建阴道分娩产妇分娩期全流程护理方案并评价其应用效果。方法在文献分析的基础上结合德尔菲专家函询法，构建阴道分娩产妇分娩期全流程护理方案。2023年6月—9月，采用便利抽样法，选取在宁夏回族自治区某三级甲等专科医院拟行阴道分娩的180名产妇作为研究对象，其中，8月—9月的产妇为试验组，6月—7月的产妇为对照组。试验组在常规护理的基础上接受分娩期全流程护理方案，对照组进行常规护理，比较两组分娩结局相关指标（分娩方式、各产程时间等）、分娩疼痛程度、分娩恐惧及分娩体验。结果 2轮专家函询的有效问卷回收率分别为100%、93.75%，专家权威系数均为0.85。构建的方案包括3个一级条目、10个二级条目及29个三级条目。最终，试验组与对照组分别纳入86名、85名产妇。干预后，两组各产程时间比较，差异均具有统计学意义（P<0.05）；疼痛控制优良率比较，差异具有统计学意义（χ²=16.386，P<0.001）；试验组分娩恐惧量表得分为（27.76±3.60）分，低于对照组的（33.06±3.36）分，分娩体验问卷得分为（80.83±4.83）分，高于对照组的（75.79±3.46）分，差异均具有统计学意义（P<0.001）。结论阴道分娩产妇分娩期全流程护理方案具有较好的科学性、可行性，应用该方案可缩短产妇各产程时间，减轻分娩疼痛、分娩恐惧，改善分娩体验。

关键词: 阴道分娩, 全流程, 分娩恐惧, 分娩体验, 产科护理

Abstract:

Objective To construct a whole process nursing plan for women with vaginal delivery and to evaluate its effect. Methods On the basis of literature analysis and Delphi expert consultation method，a whole process nursing plan of vaginal delivery was established. From June to September 2023，180 primiparas in a tertiary A hospital in Ningxia were selected as research subjects to carry out the preliminary application of the plan. Among them，the parturients hospitalized from August to September were in the experimental group，and those hospitalized from June to July were in the control group. The experimental group received the whole process nursing plan on the basis of routine nursing，and the control group received routine nursing. The indexes related to delivery outcomes（delivery mode，time of each labor stage，et al），the degree of labor pain，fear of labor and labor experience were compared between the 2 groups. Results The effective recovery rates of the 2 rounds of expert correspondence were 100% and 93.75%，respectively，and the coefficient of expert authority was 0.85. The finally constructed plan included 3 first-level items，10 second-level items and 29 third-level items. 86 cases and 85 cases were included in the experimental group and the control group，respectively. After intervention，there were statistically significant differences in each stage of labor between the 2 groups（P<0.05）. There was significant difference in the rate of good and good control of labor pain（χ²=16.386，P<0.001）. The childbirth fear questionnaire score（27.76±3.60） of the experimental group was lower than（33.06±3.36） of the control group，and the childbirth experience score（80.83±4.83） was higher than（75.79±3.46） of the control group，and the differences were statistically significant（P<0.001）. Conclusion The whole process nursing plan of vaginal delivery is scientific and feasible. It can shorten the labor time，relieve labor pain，labor fear and improve labor experience.

Key words: Vaginal Delivery, Whole Process, Fear of Childbirth, Birth Experience, Obstetrical Nursing

白雪, 张广意, 马嫔, 张燕, 吉双对, 米光丽. 阴道分娩产妇分娩期全流程护理方案的构建及应用研究[J]. 中华护理杂志, 2025, 60(1): 10-17.

BAI Xue, ZHANG Guangyi, MA Pin, ZHANG Yan, JI Shuangdui, MI Guangli. Construction and application of a whole process nursing plan for women in vaginal delivery[J]. Chinese Journal of Nursing, 2025, 60(1): 10-17.

图/表 4

表1 分娩期全流程护理方案

Table 1 The whole process nursing plan during childbirth

表2 两组分娩结局相关指标的比较

Table 2 Comparison of indicators related to delivery outcomes between the 2 groups

表3 两组分娩恐惧量表得分比较（分，$\bar{x} \pm s$）

Table 3 Comparison of fear of childbirth between the 2 groups（score，$\bar{x} \pm s$）

表4 两组分娩体验问卷得分比较（分，$\bar{x} \pm s$）

Table 4 Comparison of childbirth experience scores between the 2 groups（score，$\bar{x} \pm s$）

参考文献 16

[1]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018.
	Xie X, Kong BH, Duan T. Obstetrics and gynecology[M]. 9th ed. Beijing: People’s Medical Publishing House, 2018.
[2]	Oskoui BS, Mehrabi E, Nourizadeh R, et al. The effect of mindfulness-based counseling on the childbirth experience of primiparous women:a randomized controlled clinical trial[J]. BMC Pregnancy Childbirth, 2023, 23(1):274.
[3]	Ahmadpour P, Moosavi S, Mohammad-Alizadeh-Charandabi S, et al. Effect of implementing a birth plan on maternal and neonatal outcomes:a randomized controlled trial[J]. BMC Preg-nancy Childbirth, 2022, 22(1):862.
[4]	燕美琴, 王娇, 刘亦娜, 等. 群组孕期保健模式在妊娠期糖尿病孕妇分娩结局中的效果研究[J]. 中华护理杂志, 2021, 56(9):1305-1311. DOI URL
	Yan MQ, Wang J, Liu YN, et al. Observation on the effect of group health care model during pregnancy in childbirth outcome of pregnant women with gestational diabetes[J]. Chin J Nurs, 2021, 56(9):1305-1311. DOI URL
[5]	燕美琴, 闫高慧, 任永莲, 等. 积极心理干预对孕妇分娩恐惧和总体幸福感的影响[J]. 中华护理杂志, 2022, 57(24):2957-2963. DOI URL
	Yan MQ, Yan GH, Ren YL, et al. Effects of positive psycho-logical interventions on maternal labor fear and general well-being[J]. Chin J Nurs, 2022, 57(24):2957-2963.
[6]	俞晓晶, 徐雪芬, 许莉莉, 等. 基于虚拟现实技术的产前健康教育课程的构建及应用[J]. 中华护理杂志, 2024, 59(2):184-190. DOI URL
	Yu XJ, Xu XF, Xu LL, et al. Construction and application of prenatal health education curriculum based on virtual simulation technology[J]. Chin J Nurs, 2024, 59(2):184-190. DOI URL
[7]	王美燕. 基于赋权理论的分娩计划对初产妇分娩的影响研究[D]. 衡阳: 南华大学, 2019.
	Wang MY. Research on the effect of birth plan based on empowerment theory on the childbirth of primipara[D]. Hengyang: University of South China, 2019.
[8]	Tanglakmankhong K, Perrin NA, Lowe NK. Childbirth Self-Efficacy Inventory and Childbirth Attitudes Questionnaire:psychometric properties of Thai language versions[J]. J Adv Nurs, 2011, 67(1):193-203. DOI PMID
[9]	危娟, 刘洁英, 张莉芳, 等. 分娩恐惧量表的汉化及信效度检测[J]. 护理学杂志, 2016, 31(2):81-83.
	Wei J, Liu JY, Zhang LF, et al. Reliability and validity of the Chinese version of Childbirth Attitudes Questionnaire[J]. J Nurs Sci, 2016, 31(2):81-83.
[10]	Dencker A, Taft C, Bergqvist L, et al. Childbirth Experience Questionnaire(CEQ):development and evaluation of a multidimensional instrument[J]. BMC Pregnancy Childbirth, 2010,10:81.
[11]	廖培培. 自然分娩产妇分娩体验的研究[D]. 合肥: 安徽医科大学, 2016.
	Liao PP. The study of maternal childbirth experience of spontaneous labor[D]. Hefei: Anhui Medical University, 2016.
[12]	白云波, 徐铭军. 右美托咪定用于分娩镇痛中转剖宫产术的临床效果观察[J]. 北京医学, 2019, 41(8):679-682.
	Bai YB, Xu MJ. The clinical effect of dexmedetomidine in labor analgesia switch to epidural cesarean section anesthesia[J]. Beijing Med J, 2019, 41(8):679-682.
[13]	Palmer CM, Jiang YD. Limiting oral intake during labor:do we have it right?[J]. Anesthesiology, 2022, 136(4):528-530.
[14]	Karkada SR, Noronha JA, Bhat SK, et al. Effectiveness of an-tepartum breathing exercises on the outcome of labour:a ran-domized controlled trial[J]. F1000Res, 2022,11:159.
[15]	杨飞燕, 吴巧珠, 苏丹, 等. 音乐疗法结合导乐陪伴对自然分娩产妇负性情绪及疼痛的影响[J]. 中国健康心理学杂志, 2022, 30(8):1175-1179.
	Yang FY, Wu QZ, Su D, et al. Effect of music therapy combined with Doula companionship on negative emotion and pain of parturient in natural delivery[J]. China J Health Psychol, 2022, 30(8):1175-1179.
[16]	Viirman F, Hesselman S, Wikström AK, et al. Negative childbirth experience-what matters most? A register-based study of risk factors in three time periods during pregnancy[J]. Sex Reprod Healthc, 2022,34:100779.