【摘要】 目的 探究在第二产程延长或停滞时分别应用低位产钳术和剖宫产术对产妇围产期指标及新生儿预后的影响。方法 回顾性选取2019年6月至2021年1月在南方医科大学附属东莞医院阴道试产且第二产程延长或停滞的120例产妇为研究对象，根据分娩方式的不同分为低位产钳术组(n=65)和剖宫产术组(n=55)。比较两组产妇围产期指标(包括第二产程时间、胎儿头部娩出时间、产时出血量、产后出血量和住院时间)及新生儿预后结局。结果 低位产钳术组产妇的第二产程时间[(141.26±18.33) min vs.(152.02±19.11) min]、胎儿头部娩出时间[(6.14±0.89)min vs.(7.87±1.02) min]、产时出血量[(151.34±36.58) m L vs.(226.71±45.84) m L]、产后出血量[(177.52±41.55)m L vs.(231.35±56.80) m L]和住院时间[(3.94±0.88) d vs.(7.02±1.19) d]均明显低于对照组，差异均有统计学意义(P <0.05)。两组新生儿的出生体重[(3.82±0.69) kg vs.(3.84±0.71) kg]、1 min Apgar评分[(9.11±1.02)分vs.(9.09±0.98)分]、5 min Apgar评分[(9.45±1.36)分vs.(9.51±1.38)分]和脐带血pH值[(7.16±0.64) vs.(7.09±0.55)]比较，差异均无统计学意义(P>0.05)。低位产钳术组新生儿酸中毒、头皮血肿的发生率分别为3.08%、1.54%，明显低于剖宫产术组的14.55%、10.91%，差异均有统计学意义(P <0.05);两组新生儿窒息(1.54%vs. 7.27%)、新生儿死亡(0 vs. 1.82%)、皮肤损伤(1.54%vs. 9.09%)的发生率比较，差异均无统计学意义(P> 0.05)。结论 低位产钳术助产可有效缩短分娩时间，减少产妇产时和产后出血量，降低新生儿并发症等不良预后风险，既可有效处置第二产程延长或停滞，也可降低剖宫产率。更多还原

【Abstract】 Objective To investigate the effects of low forceps and cesarean section on perinatal indexes and neonatal prognosis in prolonged or stagnant second stage of labor. Methods A total of 120 women who underwent vaginal trial labor and prolonged or stagnated second stage of labor in Dongguan Hospital,Southern Medical University( Dongguan People’s Hospital) from June 2019 to January 2021 were retrospectively selected as the research objects. They were divided into low forceps group( n = 65) and cesarean section group( n = 55) according to different delivery methods. The perinatal indexes( including the time of the second stage of labor,the time of fetal head delivery,intrapartum blood loss,postpartum blood loss and length of hospital stay) and neonatal prognosis were compared between the two groups. Results The duration of the second stage of labor in the low forceps group and the cesarean section group [( 141. 26 ± 18. 33) min vs.( 152. 02 ± 19. 11) min],the time of fetal head delivery [( 6. 14 ± 0. 89) min vs.( 7. 87 ± 1. 02) min],the amount of intrapartum hemorrhage [( 151. 34 ± 36. 58) m L vs.( 226. 71± 45. 84) m L],The amount of postpartum hemorrhage [( 177. 52 ± 41. 55) m L vs.( 231. 35 ± 56. 80) m L] and the duration of hospitalization[( 3. 94 0. 88) d vs.( 7. 02 ± 1. 19) d]were significantly different( P < 0. 05). There was no statistical difference in the birth weight [( 3. 82± 0. 69) kg vs.( 3. 84 ± 0. 71) kg],1min Apgar score [( 9. 11 ± 1. 02) vs.( 9. 09 ± 0. 98) ],5 min Apgar score [( 9. 45 ± 1. 36) vs.( 9. 51 ±1. 38) ],and cord blood p H [( 7. 16 ± 0. 64) vs.( 7. 09 ± 0. 55) ]between the two groups( P > 0. 05). The incidence rates of neonatal acidosis and scalp hematoma in the low forceps operation group were 3. 08% and 1. 54%,respectively,significantly lower than 14. 55% and 10. 91% of those in the cesarean section group( P < 0. 05). There was no statistical difference in the incidence of neonatal asphyxia( 1. 54% vs. 7. 27%),neonatal death( 0 vs. 1. 82%) and skin injury( 1. 54% vs. 9. 09%) between the two groups( P > 0. 05). Conclusion Low forceps delivery can effectively shorten the delivery time,reduce the maternal intrapartum and postpartum hemorrhage,and reduce the risk of adverse prognosis such as neonatal complications,which can effectively deal with the extension or stagnation of the second stage of labor and reduce the rate of cesarean section.更多还原