（商丘市第一人民医院产科 河南商丘 476100）
[摘要] 目的 探究产妇分娩过程中加强助产士沟通对妊娠结局及焦虑状态的影响。方法 选择2016年12月-2017年4月期间在商丘市第一人民医院产科分娩的25例产妇作为对照组，选择2017年5月-2017年9月期间在商丘市第一人民医院产科分娩的25例产妇作为观察组，对照组采取常规沟通模式，观察组实施助产士强化沟通。比较两组产妇妊娠结局与不同时间产妇的焦虑状态。结果 观察组剖宫产率、产后出血率、盆腔粘连率及产褥感染率均低于对照组，差异有统计学意义（P＜0.05）；观察组第一产程与产后2h焦虑状态评分均低于对照组，差异有统计学意义（P＜0.05）。结论 产妇分娩过程中加强助产士与产妇之间的沟通，可缓解患者负性情绪，改善妊娠结局。
[关键词] 产妇；助产士强化沟通；妊娠结局；焦虑状态
The effect of midwife's enhanced communication on maternal pregnancy outcome and anxiety status
Kang Na (Department of Obstetrics, the First People's Hospital of Shangqiu, Shangqiu, Henan 476100)
[Abstract] Objective To explore the effect of strengthening midwife communication on pregnancy outcomes and anxiety state during maternal delivery. Methods A total of 25 maternity women from the Obstetrics Department of the First People's Hospital of Shangqiu City during the period from December 2016 to April 2017 were selected as a control group. During the period from May 2017 to September 2017, they were selected for delivery at the First People's Hospital of Shangqiu City. Twenty-five cases of maternal women were used as the observation group, and the control group used the normal communication mode. The observation group implemented midwifery to strengthen communication. The maternal pregnancy outcome and maternal anxiety were compared between the two groups. Results The cesarean section rate, postpartum hemorrhage rate, pelvic adhesion rate and puerperal infection rate in the observation group were lower than those in the control group (P<0.05). The anxiety scores in the observation group were low during the first stage of labor and 2h after delivery. In the control group, the difference was statistically significant (P<0.05). Conclusion The strengthening of communication between midwives and mothers during maternal delivery can relieve negative emotions and improve pregnancy outcomes.
[Key words] Maternal; Midwives strengthen communication; Pregnancy outcomes; AnxietyThe effect of midwife's enhanced communication on maternal pregnancy outcome and anxiety status
Kang Na (Department of Obstetrics, the First People's Hospital of Shangqiu, Shangqiu, Henan 476100)
[Abstract] Objective To explore the effect of strengthening midwife communication on pregnancy outcomes and anxiety state during maternal delivery. Methods A total of 25 maternity women from the Obstetrics Department of the First People's Hospital of Shangqiu City during the period from December 2016 to April 2017 were selected as a control group. During the period from May 2017 to September 2017, they were selected for delivery at the First People's Hospital of Shangqiu City. Twenty-five cases of maternal women were used as the observation group, and the control group used the normal communication mode. The observation group implemented midwifery to strengthen communication. The maternal pregnancy outcome and maternal anxiety were compared between the two groups. Results The cesarean section rate, postpartum hemorrhage rate, pelvic adhesion rate and puerperal infection rate in the observation group were lower than those in the control group (P<0.05). The anxiety scores in the observation group were low during the first stage of labor and 2h after delivery. In the control group, the difference was statistically significant (P<0.05). Conclusion The strengthening of communication between midwives and mothers during maternal delivery can relieve negative emotions and improve pregnancy outcomes.
[Key words] Maternal; Midwives strengthen communication; Pregnancy outcomes; Anxiety
分娩过程分为三个产程，分娩时子宫收缩，产妇整个分娩过程需承受分娩痛苦，且随着产程进展，疼痛愈烈，产妇多出现焦虑、紧张、恐惧等不良情绪，加上激素水平的改变，可导致子宫收缩乏力、难产、产后出血等一系列生理反应，危及母婴生命安全[1]。相关研究指出，助产士在产妇分娩过程中承担着重要责任，助产士与产妇之间强化沟通有利于改善产妇不良情绪，降低应激反应，对缩短产程与减少产妇体能消耗具有积极意义[2]。本研究旨在探讨产妇分娩过程中强化助产士沟通模式对产妇妊娠结局及焦虑状态的影响。现报道如下。
1资料与方法
1.1 一般资料 选择2016年12月-2017年4月期间在商丘市第一人民医院产科分娩的25例产妇作为对照组，年龄21-36岁，平均（28.53±2.14）岁；孕周37-42周，平均（39.53±0.79）周。选择2017年5月-2017年9月期间在商丘市第一人民医院产科分娩的25例产妇作为观察组，年龄22-35岁，平均（28.28±2.32）岁；孕周38-42周，平均（39.81±0.72）周。两组一般资料相比，差异无统计学意义（P＞0.05），具有可比性。本研究经我院伦理委员会批准，患者对本研究知情并签署同意书。
1.2 方法 对照组行常规沟通模式，做好常规产前检查与孕期指导。观察组在此基础上由助产士强化沟通，具体内容：①产前：积极与产妇深入沟通，了解产妇需求，面带笑容，语言轻柔，讲解产程与分娩过程中可能出现的不适感，讲解分娩技巧，缓解产妇紧张、焦虑情绪，全程陪伴，给予精神支持，并指导其适当运动。②第一产程：倾听轻柔音乐，积极与产妇沟通，转移注意力。③第二产程：监测产妇生命体征，指导产妇正确深呼吸、屏气用力、使用腹压等分娩技巧，言语鼓励，提高分娩信心，分娩成功后，表示由衷祝福。④第三产程：早期母婴接触，教授正确喂养方法，促进乳腺疏通，预防涨奶。
1.3 评价指标 ①比较两组产妇妊娠结局，包括剖宫产、产后出血、盆腔粘连、产褥感染。②比较两组产妇第一产程与产后2h焦虑状态，采用汉密尔顿焦虑量表（HAMA）[3]评估，总分56分，分值越高表明焦虑状况越严重。
1.4 统计学方法 采用SPSS 20.0统计学软件，计数资料以百分数和例数表示，组间比较采用χ2检验；计量资料采用“ ±s”表示，组间比较采用t检验；以P＜0.05为差异有统计学意义。
2 结果
2.1 产妇妊娠结局 观察组剖宫产率、产后出血率、盆腔粘连率及产褥感染率均低于对照组，差异有统计学意义（P＜0.05）。见表1。
3 讨论
分娩痛苦对产妇是一种强烈而持久的应激，绝大多数产妇对产痛充满着紧张与恐惧，负性情绪可引起中枢神经系统功能紊乱，增加体内儿茶酚胺与肾上腺素分泌，增加交感神经兴奋性，延长产程，增加心理应激反应，进而导致肌肉紧张，增加痛觉敏感性，形成恶性循环。由此可以看出，产妇良好的心理状态及生理状态对减轻分娩痛苦具有积极意义，同时可保障胎儿身体健康，减少新生儿不良妊娠结局。
据相关研究表明，提前对产妇进行认知干预，使其提前了解要面对的应激事件可在一定程度上缓解心理与生理上的应激反应[4]。本研究结果显示，观察组产妇不同时间段焦虑状态评分低于对照组，且剖宫产率及产妇不良妊娠结局的发生率均低于对照组，表明助产士强化沟通模式有助于缓解产妇不良情绪，减轻心理及生理应激反应，降低剖宫产率，改善妊娠结局。本研究通过强化助产士与产妇之间的沟通，以亲切温和的语言与产妇交流，增加产妇对助产士的信任感，提前告知产妇分娩过程、注意事项与分娩技巧，让产妇对整个分娩过程有了详细认知，并且给予专业支持与心理疏导，增加产妇对分娩的信心，减轻焦虑恐惧等负性情绪，从而达到缓解应激反应的目的[5]。助产士应充分掌握分娩配合方法，根据产程进展，实施全程陪伴指导，对分娩过程中存在的不适感应积极进行解释，让产妇产生一定的心理预期，提高产妇分娩的依从性，使产妇分娩过程中处于最佳心理状态，缩短产程，提高自然分娩率，保障母婴健康，分娩成功后及时与产妇分享喜悦，并进行后续指导，提高整体服务质量，增加产妇满意度[6]。
综上所述，助产士强化沟通模式可缓解产妇分娩过程中的焦虑状态，降低心理应激反应，减轻生理痛苦，加快产程，促进胎儿顺利娩出，改善妊娠结局。
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论文作者:康娜
论文发表刊物:《中国医学人文》2018年第3期
论文发表时间:2018/6/5
标签：产妇论文; 助产士论文; 焦虑论文; 结局论文; 商丘市论文; 状态论文; 统计学论文; 《中国医学人文》2018年第3期论文;