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目的探讨“四肢着床”操作法处理肩难产对母婴结局的影响。方法收集2009年8月至2014年12月收治的65例肩难产产妇资料,按处理方法不同将产妇分为观察组35例和对照组30例。观察组产妇采用“四肢着床”操作法处理肩难产,对照组产妇采用传统牵拉胎头法、屈大腿加耻骨上加压进行处理,记录两组新生儿胎头至胎肩的娩出时间,并观察两组新生儿窒息、臂丛神经损伤、锁骨骨折、颅内出血的发生情况以及产妇会阴伤口延裂及产后出血等情况。结果观察组新生儿胎头至胎肩的娩出时间明显短于对照组(t=6.394,P<0.05)。观察组新生儿窒息、臂丛神经损伤、锁骨骨折、颅内出血的发生率分别为0.0%、2.9%、2.9%、0.0%,对照组新生儿窒息、臂丛神经损伤、锁骨骨折、颅内出血的发生率分别为10.0%、10.0%、30.0%、2.9%,除了颅内出血,观察组新生儿并发症发生率均明显低于对照组(均P<0.05)。观察组产妇会阴伤口延裂发生率明显低于对照组(P<0.05)。结论 “四肢着床”操作法是处理肩难产的一种安全、有效、快速的方法,操作简单,能明显降低母婴并发症的发生。
Objective To investigate the effect of shoulder discomfort on maternal and infant outcome with “limbs implantation method”. Methods 65 cases of shoulder dystocia who were treated from August 2009 to December 2014 were collected. According to the different treatment methods, 35 cases were divided into observation group and 30 cases in control group. In the observation group, maternal treatment of shoulder dystocia by “limbs implants” operation method was adopted. In the control group, the maternal women were treated with traditional traction fetal head method, pressure on the thigh and pubis, and the delivery of the newborns to the shoulder was recorded Time, and observed neonatal asphyxia, brachial plexus injury, clavicular fracture, intracranial hemorrhage and maternal perineal wound rupture and postpartum hemorrhage and so on. Results The birth time of fetal head to shoulder of observation group was significantly shorter than that of control group (t = 6.394, P <0.05). The incidences of neonatal asphyxia, brachial plexus injury, clavicular fracture and intracranial hemorrhage in the observation group were 0.0%, 2.9%, 2.9% and 0.0% respectively. In the control group, neonatal asphyxia, brachial plexus injury, clavicular fracture and intracranial hemorrhage The incidence rates of neonatal complications in observation group were significantly lower than those in control group (10.0%, 10.0%, 30.0% and 2.9%, respectively) except for intracranial hemorrhage (all P <0.05). The incidence of perineal wound rupture in observation group was significantly lower than that in control group (P <0.05). Conclusion The limbs implantation method is a safe, effective and rapid method for shoulder dystocia. The operation is simple and can significantly reduce the incidence of maternal and infant complications.