标题：中心群组化孕期保健模式联合循证护理对高龄孕妇剖宫产率、妊娠结局及母乳喂养情况的影响

      作者：黄伟妍，李文君，夏斌    东莞市人民医院产科，广东 东莞 523000

      卷次： 2024年35卷12期

      【摘要】 目的 探讨中心群组化孕期保健模式联合循证护理对高龄孕妇剖宫产率、妊娠结局及母乳喂养情况的影响。方法 选择2021年12月至2023年8月东莞市人民医院产科收治的90例高龄孕妇作为研究对象，按照随机数字分配法分为观察组和对照组各45例。对照组孕妇接受传统孕期保健模式，观察组孕妇给予中心群组化孕期保健模式联合循证护理，孕期保健及护理从孕妇入组开始直至孕妇分娩。自制调查问卷调查两组孕妇的孕期相关知识了解程度，所有孕妇于孕32周前完成第一次问卷调查，包括孕期活动、产前检查、孕期饮食三个维度；所有孕妇于孕 35周前完成第二次问卷调查，包括胎儿保健和分娩知识两个维度。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)分别于孕妇入组时、分娩后2 h评价两组孕妇的负面情绪。比较两组孕妇的第一产程、第二产程、第三产程及总产程时间以及分娩方式、产后出血量、新生儿Apgar评分和母乳喂养技能量表(LATCHES)评分。结果 观察组孕妇的孕期活动、产前检查、孕期饮食、胎儿保健和分娩知识得分分别为(18.86±1.19)分、(18.21±1.03)分、(18.06±0.94)分、(19.11±1.13)分、(18.23±0.98)分，明显高于对照组的(17.51±0.86)分、(17.34±0.91)分、(17.02±0.75)分、(17.89±0.85)分、(17.42±0.81)分，差异均有统计学意义(P<0.05)；观察组孕妇分娩后 2 h的 SAS、SDS评分分别为(44.23±5.38)分、(43.19±5.03)分，明显低于对照组的(48.71±6.43)分、(47.34±6.19)分，差异均有统计学意义(P<0.05)；观察组孕妇的第一产程、第二产程、第三产程和总产程时间分别为(198.75±51.92) min、(38.61±10.02) min、(6.23±1.14) min、(239.06±62.41) min，明显短于对照组的(241.26±62.37) min、(53.46±14.71) min、(7.86±1.82) min、(312.23±78.09) min，差异均有统计学意义(P<0.05)；观察组孕妇的剖宫产率为 11.11%，明显低于对照组的 31.11%，观察组的产后出血量为(264.48±31.23) mL，明显低于对照组的(311.65±46.74) mL，新生儿Apgar评分和LATCHES量表评分分别为(9.26±0.51)分、(31.27±3.23)分，明显高于对照组的(8.74±0.37)分、(28.03±2.16)分，差异均有统计学意义(P<0.05)。结论 中心群组化孕期保健模式联合循证护理能够有效提高高龄孕妇对孕期相关知识的了解程度和自我管理能力，孕妇孕期的负面情绪得到有效缓解，产程明显缩短，剖宫产率明显降低，孕妇的母乳喂养状况得到显著改善。
      【关键词】 高龄孕妇；中心群组化孕期保健模式；循证护理；妊娠结局；剖宫产率；母乳喂养
      【中图分类号】 R473.71 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1809—05

Influence of center-grouped pregnancy health care model combined with evidence-based nursing on cesareansection rate, pregnancy outcome, and breastfeeding of elderly pregnant women.
HUANG Wei-yan, LI Wen-jun, XIABin. Department of Obstetrics, Dongguan People's Hospital, Dongguan 523000, Guangdong, CHINA
【Abstract】 Objective To explore the influence of center-grouped pregnancy health care model combined withevidence-based nursing on cesarean section rate, pregnancy outcome, and breastfeeding of elderly pregnant women.Methods Ninety elderly pregnant women admitted to Department of Obstetrics, Dongguan People's Hospital from De-cember 2021 to August 2023 were selected and randomly divided into the experimental group and the control group,with 45 patients in each group. The pregnant women in the control group received traditional pregnancy care model,while those in the experimental group were given center-grouped pregnancy health care model combined with evi-dence-based nursing. Self-made questionnaires were used to investigate the understanding of pregnancy-related knowl-edge in the two groups of pregnant women. All pregnant women completed the first questionnaire survey before 32weeks of pregnancy, including three dimensions: pregnancy activities, prenatal examination, and diet during pregnancy.They completed the second questionnaire survey before 35 weeks of pregnancy, including two dimensions: fetal healthcare and delivery knowledge. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to eval-uate the negative emotions of pregnant women in the two groups when they entered the group and 2 hours after delivery.The first stage of labor, the second stage of labor, the third stage of labor, the total time of labor, the mode of delivery, theamount of postpartum hemorrhage, Apgar score of newborn, and the score of breastfeeding skills scale (LATCHES)were statistically compared between the two groups. Results The scores of pregnant women in the experimental groupwere (18.86±1.19) points, (18.21±1.03) points, (18.06±0.94) points, (19.11±1.13) points, and (18.23±0.98) points, whichwere significantly higher than (17.51±0.86) points, (17.34±0.91) points, (17.02±0.75) points, (17.89±0.85) points, and(17.42±0.81) points of the control group (P<0.05). The scores of SAS and SDS in the experimental group at 2 hours afterdelivery were (44.23±5.38) points and (43.19±5.03) points, respectively, which were significantly lower than (48.71±6.43) points and (47.34±6.19) points in the control group (P<0.05). The first stage of labor, the second stage of labor, thethird stage of labor, and the total stage of labor in the experimental group were (198.75±51.92) min, (38.61±10.02) min,(6.23 ± 1.14) min, and (239.06 ± 62.41) min, which were significantly shorter than (241.26 ± 62.37) min, (53.46 ±14.71) min, (7.86±1.82) min, and (312.23±78.09) min in the control group (P<0.05). The cesarean section rate in the ex-perimental group (11.11%) was significantly lower than that in the control group (31.11%); the postpartum hemorrhagevolume of the observation group was (264.48±31.23) mL, which was significantly lower than (311.65±46.74) mL of thecontrol group; the neonatal Apgar score and LATCHES scale score were (9.26±0.51) points and (31.27±3.23) points,which were significantly higher than (8.74±0.37) points and (28.03±2.16) points of the control group; the differenceswere statistically significant (P<0.05). Conclusion The center-grouped pregnancy care model combined with evi-dence-based nursing can effectively improve the understanding and self-management ability of elderly pregnant womenabout pregnancy-related knowledge, which results in effectively alleviated negative emotions of pregnant women, signifi-cantly shortened labor process, significantly reduced cesarean section rate, and significantly improved breastfeeding situ-ation of pregnant women.
      【Key words】 Elderly pregnant women; Center-grouped pregnancy health care model; Evidence-based nursing;Pregnancy outcome; Cesarean section rate; Breastfeeding