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投稿时间：2025-05-04 网络发布日期：2025-12-25
投稿时间：2025-05-04 网络发布日期：2025-12-25
中文摘要: 目的 探讨肩难产产妇采用旋后肩法助产对产后盆底肌功能短期改善效果及对盆底肌形态变化、母婴并发症等指标的影响。方法 回顾性分析2022年3月至2024年8月石家庄市妇幼保健院收治的74例肩难产产妇的临床资料，进行旋后肩法助产的38例为观察组，进行耻骨联合上加压法助产的36例为对照组。比较两组新生儿1min 阿氏（Apgar）评分、出肩时间、新生儿并发症、产妇并发症、盆底表面肌电图检测结果、健康状况评分。结果 观察组新生儿1minApgar评分高于对照组［（9.32±0.70）分vs（7.89±1.24）分，t=6.064，P<0.01］，出肩时间短于对照组［（99.65±15.46）s vs（114.41±16.74）s，t=3.939，P<0.01］。观察组新生儿并发症和产妇软产道损伤、产后出血、子宫破裂、产褥感染发生率低于对照组（P<0.05）。产妇盆底表面肌电图检测结果显示，两组耐力肌收缩最大值比较差异无统计学意义（P>0.05），观察组前基线值、后基线值、快肌收缩最大值、混合肌收缩平均值、混合肌收缩最大值、耐力肌收缩平均值均优于对照组（P<0.05）。观察组健康状况评分中的社会功能、情感职能、生理机能和生理职能评分高于对照组（P<0.05）。结论 旋后肩法助产用于肩难产产妇，效果显著，可快速、安全地娩出胎肩，降低新生儿窒息率，减少产妇产后出血、软产道损伤的发生，改善短期内盆底肌功能，从而保障母婴安全。
Abstract:Objective To explore the effects of posterior shoulder rotation on the short-term improvement of pelvic floor muscle function and changes in pelvic floor muscle morphology, as well as maternal and infant complications. Methods The clinical data of 74 cases of shoulder dystocia admitted to Shijiazhuang Maternal and Child Health Hospital from March 2022 to August 2024 were analyzed retrospectively. Thirty-eight cases were assisted by posterior shoulder rotation (as observation group), and 36 cases were assisted by pubic symphysis compression (as control group). The 1 min Apgar score, shoulder-deliver time, neonatal complications, maternal complications, pelvic floor surface electromyography and health status score were compared between the two groups. Results In the observation group, 1 min Apgar score of newborns was higher than that in the control group (9.32±0.70 vs 7.89±1.24, t=6.064, P< 0.01), while shoulder-deliver time of newborns was shorter than that in the control group [ (99.65±15.46) s vs (114.41± 16.74) s, t=3.939, P<0.01]. Compared with the control group, the incidences of neonatal complications, and maternal soft birth canal injury, postpartum hemorrhage, uterine rupture and postpartum infection were lower (P<0.05). The results of pelvic floor surface electromyography for parturient showed that there was no significant difference in the maximum value of endurance muscle contraction between the two groups (P>0.05), while the pre-baseline value, post- baseline value, maximum value of fast muscle contraction, average value and maximum value of mixed muscle contraction, and average value of endurance muscle contraction in the observation group surpassed to the control group (P<0.05). Compared with the control group, the observation group had higher health status scores including social function, emotional function, physiological function, and physiological function (P<0.05). Conclusion The posterior shoulder rotation is effective for parturient with shoulder dystocia, which can deliver neonatal shoulder quickly and safely, reduce the incidence of neonatal asphyxia, maternal postpartum hemorrhage and soft birth canal injuries, and improve pelvic floor muscle function in a short duration, thus ensuring the safety of mothers and newborns.
keywords: Shoulder dystocia Parturient Posterior shoulder rotation Midwifery Pelvic floor muscle function Pelvic floor muscle shape
文章编号： 中图分类号：R717 文献标志码：A
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附件
| 作者 | 单位 |
| 温明霞 | 石家庄市妇幼保健院盆底康复科,河北 石家庄 050000 |
| 李莉 | 石家庄市妇幼保健院盆底康复科,河北 石家庄 050000 |
| 王晓辉 | 中国医学科学院北京协和医院妇产科,北京 100000 |
| 李平 | 石家庄市妇幼保健院盆底康复科,河北 石家庄 050000 |
引用文本：
温明霞,李莉,王晓辉,等.旋后肩法助产对肩难产产妇产后短期盆底肌功能及形态的影响[J].中国临床研究,2025,38(12):1927-1930.
温明霞,李莉,王晓辉,等.旋后肩法助产对肩难产产妇产后短期盆底肌功能及形态的影响[J].中国临床研究,2025,38(12):1927-1930.