Abstract:

Objective To investigate the efficacy of combining the arched back position with the open glottis technique during the second stage of labor in primiparous women receiving epidural analgesia for childbirth，aiming to provide references for optimizing midwifery practices in China. Methods Using convenience sampling，200 primiparous women undergoing epidural analgesia for labor at a tertiary-level A obstetrics and gynecology hospital in Nanjing from June to September 2024 were enrolled. They were randomly assigned to an experimental group and a control group using a random number table，with 100 women in each group. The experimental group employed the arched back position combined with glottis opening during the second stage of labor，while the control group used the flexed-leg semi-recumbent position combined with traditional glottis closure. Differences between groups were compared regarding duration of the second stage of labor，episiotomy，severity of perineal lacerations，blood loss at 2 and 24 hours postpartum，mode of delivery，perineal edema，perineal pain intensity，and fatigue levels. Results Ultimately，98 cases in the experimental group and 95 cases in the control group completed the study. The second stage of labor duration in the experimental group was（35.08±10.55） min，lower than（47.72±12.49） min in the control group. The episiotomy rate was 13.27%，and the rate of second-degree perineal lacerations was 11.76%，both lower than 25.26% and 26.76% in the control group，respectively. Postpartum bleeding volumes at 2 hours and 24 hours were（281.56±62.33） mL and（330.97±63.08） mL，respectively，lower than（318.61±88.47） mL and（365.72±89.08） mL in the control group. The spontaneous delivery rate was 96.94%，higher than the control group at 87.37%. Perineal edema and pain intensity were lower than those in the control group. The Li Fatigue Scale score was（4.89±0.62） points，lower than（6.12±0.77） points in the control group. Comparisons between the 2 groups showed statistically significant differences（P<0.05）. Conclusion The use of the arched back position combined with the open glottis technique under epidural analgesia for labor can increase the rate of spontaneous vaginal delivery in primiparas，shorten the duration of the second stage of labor，reduce the severity of perineal injury and the volume of postpartum hemorrhage，and alleviate maternal fatigue.

Key words: Epidural Analgesia, Labor Position, Open-Glottis Pushing, Second Stage of Labor, Obstetric Nursing

摘要： 目的 探讨硬膜外分娩镇痛初产妇第二产程中应用拱背体位联合开放声门法的效果，旨在为优化助产实践提供参考。方法 采用便利抽样法，选取2024年6—9月在南京市某三级甲等妇产医院行硬膜外分娩镇痛的200名初产妇作为研究对象，使用随机数字表法将其分为试验组与对照组，每组各100名。试验组第二产程采用拱背体位联合开放声门法，对照组采用屈腿半卧位联合传统关闭声门法。比较两组第二产程时长、会阴切开率、会阴裂伤程度、产后2 h及24 h出血量、分娩方式、会阴水肿及会阴疼痛程度、疲乏状况方面的差异。结果 试验组98例、对照组95例完成了该研究。试验组第二产程时长为（35.08±10.55）min，短于对照组的（47.72±12.49）min；会阴切开率为13.27%、会阴Ⅱ度裂伤率为11.76%，低于对照组的25.26%、26.76%；产后2 h及24 h的出血量为（281.56±62.33）（330.97±63.08）mL，少于对照组的（318.61±88.47）（365.72±89.08）mL；自然分娩率为96.94%，高于对照组的87.37%；会阴水肿及会阴疼痛程度低于对照组；产后1 h李氏疲乏量表得分为（4.89±0.62）分，低于对照组的（6.12±0.77）分，两组比较，差异均具有统计学意义（P<0.05）。结论 硬膜外分娩镇痛下应用拱背体位联合开放声门法可提高初产妇自然分娩率，缩短第二产程时间，减少会阴损伤程度和产后出血量，减轻产妇疲乏感。

关键词: 硬膜外镇痛, 分娩体位, 开放声门, 第二产程, 产科护理