目的 探讨胎头着冠运用减张手法联合自然娩肩在降低产时会阴损伤中的应用效果，为有效降低产时会阴裂伤的发生提供临床依据。方法 2020年10月至2022年5月，采用便利抽样法选择在绍兴市某三级甲等综合性医院自然分娩的产妇286例为研究对象，按住院号尾数的单双数分为观察组（n=149）和对照组（n=137）。观察组在适度会阴保护技术上，当胎头着冠运用减张手法联合自然娩肩助产；对照组以常规的适度会阴保护技术和人工娩肩助产，比较两组产妇会阴损伤等情况。结果 观察组产妇会阴损伤、产后会阴水肿、会阴疼痛、产后住院日均低于对照组，差异均有统计学意义（均P＜0.05）；两组产妇阴道前庭损伤、新生儿出生体质量和1~5 min Apgar评分均无统计学意义（均 P＞0.05）。结论 胎头着冠运用减张手法联合自然娩肩,能有效减少产妇会阴损伤的发生，可提高产科护理质量。

Objective To explore the application of tension relaxing combined with natural shoulder delivery after crowning of fetal head in reducing intrapartum perineal injury,and to provide clinical reference for effectively reducing the incidence of intrapartum perineal laceration.Methods From October 2020 to May 2022,286 parturients who gave birth naturally in a tertiary A general hospital in Shaoxing City were selected by the convenience sampling method and divided into the observation group (n=149) and the control group (n=137) according to the odd and even number of the end number of hospitalization number.In the observation group,the moderate perineal protection technique was applied when the fetal head was crowned,combined with natural shoulder delivery.The control group was treated with conventional moderate perineal protection technique and mannal shoulder delivery.The perineal injury was compared between the two groups.Results Perineal injury,perineal edema,perineal pain and postpartum hospital stay in the observation group were lower than those in the control group,and the differences were statistically significant (all P＜0.05).There were no significant difference in vaginal vestibular injury,birth weight and Apgar score of 1 to 5 min between the two groups (all P＞0.05).Conclusion The use of tension relaxing technique combined with natural shoulder delivery can effectively reduce the occurrence of perineal injury and improve the quality of obstetric care.

R473.71

浙江省医药卫生科技计划项目（2023KY1241）