會陰保護的臨床證據_《中國循證醫學雜志》

作者：

程萌 ,  許良智

四川大學華西第二醫院婦產科（成都?610041）;

關鍵詞：

會陰保護臨床證據系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20080151

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

會陰保護是產科的一個經典問題，從古至今，人們一直在進行各種嘗試和摸索，既總結出一套有效的保護方法又在此方面進行了新的嘗試。如何評價這些方法的有效性和可靠性呢？為此筆者檢索了Cochrane圖書館（2007年第3期）、MEDLINE（1980.1～2007.5）和中國生物醫學文獻數據庫（1980.1～2007.5），收集關于會陰按摩、會陰切開、分娩鎮痛等會陰保護方面的系統評價和隨機對照試驗，對其進行歸納總結，以求為臨床工作實踐提供最佳的依據。

引用本文： 程萌,許良智. 會陰保護的臨床證據. 中國循證醫學雜志, 2008, 08(8): 673-677. doi: 10.7507/1672-2531.20080151 復制

1.	Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev, 2006, (1): CD005123.
2.	Eason E, Labrecque M, Wells G, et al. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol, 2000, 95(3): 464-471.
3.	徐小衛. 妊娠晚期會陰按摩預防產時會陰損傷的臨床觀察. 浙江臨床醫學, 2003, 5(2): 93-95.
4.	王安英. 孕晚期會陰按摩預防產時會陰損傷的療效觀察. 中國婦幼保健, 2002, 17(4): 242.
5.	Reilly ET, Freeman RM, Waterfield MR, et al. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. BJOG, 2002, 109(1): 68-76.
6.	Kovavisarach E, Jirasettasiri P. Randomised controlled trial of perineal shaving versus hair cutting in parturients on admission in labor. J Med Assoc Thai, 2005, 88(9): 1167-1171.
7.	Klein M, Papageorgiou A, Westreich R, et al. Care in a birth room versus a conventional setting: a controlled trial. Can Med Assoc J, 1984, 131(12): 1461–1466.
8.	Hodnett ED, Downe S, Edwards N, et al. Home-like versus conventional institutional settings for birth. Cochrane Database Syst Rev, 2005, (1): CD000012.
9.	Eckert K, Turnbull D, MacLennan A. Immersion in water in the first stage of labor: a randomized controlled trial. Birth, 2001, 28(2): 84-93.
10.	Cluett ER, Nikodem VC, McCandlish RE. Immersion in water in pregnancy, labour and birth. The Cochrane Database of Systematic Reviews 2006, Issue 4.
11.	董淑筠, 金皖玲, 程蔚蔚, 等. 水中分娩462例臨床分析. 上海醫學, 2005, 28(9): 737-740.
12.	Liu EH. Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ, 2004, 328(7453): 1410.
13.	Sharma SK, McIntire DD, Wiley J, et al. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology, 2004, 100(1): 142-148.
14.	Somuah MA, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
15.	Turnbull D, Holmes A, Shields N, et al. Randomised, controlled trial of efficacy of midwife-managed care. Lancet, 1996, 348(9022): 213-218.
16.	Stamp G, Kruzins G, Crowther C. Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. BMJ, 2001, 322(7297): 1277-1280.
17.	羅賢英, 吳莉娟, 包芳芳. 按摩會陰在分娩中的保護作用. 齊齊哈爾醫學院學報, 2002, 12(2): 143.
18.	Hansen SL, Clark SL, Foster JC. Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol, 2002, 99(1): 29-34.
19.	Simpson KR, James DC. Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial. Nurs Res, 2005, 54(3): 149-157.
20.	Altman D, Ragnar I, Ekström A, et al. Anal sphincter lacerations and upright delivery postures--a risk analysis from a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(2): 141-146.
21.	歸亞峰. 坐式分娩與臥式分娩的對照研究. 中國初級衛生保健, 2005, 19(12): 46-47.
22.	季平, 趙曼林, 劉春燕, 等. 會陰側切術與會陰正中切術的臨床觀察. 國際醫藥衛生導報, 2006, 12(18): 27-28. 　.
23.	Mayerhofer K, Bodner-Adler B, Bodner K, et al. Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1, 076 women. J Reprod Med, 2002, 47(6): 477-482.
24.	McCandlish R, Bowler U, van Asten H, et al. A randomised controlled trial of care of the perineum during second stage of normal labour. Br J Obstet Gynaecol, 1998, 105(12): 1262-1272.
25.	Weerasekera DS, Premaratne S. A randomised prospective trial of the obstetric forceps versus vacuum extraction using defined criteria. J Obstet Gynaecol, 2002, 22(4): 344-345.
26.	盧施吏. 陰部神經阻滯陰道擴張法在分娩中的應用. 中國社區醫師, 2005, 7(100): 21.
27.	楊華. 分娩時局部應用利多卡因對會陰的保護作用. 中國臨床醫生, 2002, 30(5): 43-44.
28.	Leroux, Nathalie. Bujold, Emmanuel. Impact of chromic catgut versus polyglactin 910 versus fast-absorbing polyglactin 910 sutures for perineal repair: a randomized, controlled trial. American Journal of Obstetrics & Gynecology, 2006, 194(6): 1585-1590.
29.	胡葉平, 徐威萍. 兩種會陰切開縫合術比較. 實用醫學雜志, 2005, 21(18): 2041-2042.
30.	Lundquist M, Olsson A, Nissen E. Is it necessary to suture all lacerations after a vaginal delivery? Birth, 2000, 27(2): 79-85.

1. Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev, 2006, (1): CD005123.
2. Eason E, Labrecque M, Wells G, et al. Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol, 2000, 95(3): 464-471.
3. 徐小衛. 妊娠晚期會陰按摩預防產時會陰損傷的臨床觀察. 浙江臨床醫學, 2003, 5(2): 93-95.
4. 王安英. 孕晚期會陰按摩預防產時會陰損傷的療效觀察. 中國婦幼保健, 2002, 17(4): 242.
5. Reilly ET, Freeman RM, Waterfield MR, et al. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. BJOG, 2002, 109(1): 68-76.
6. Kovavisarach E, Jirasettasiri P. Randomised controlled trial of perineal shaving versus hair cutting in parturients on admission in labor. J Med Assoc Thai, 2005, 88(9): 1167-1171.
7. Klein M, Papageorgiou A, Westreich R, et al. Care in a birth room versus a conventional setting: a controlled trial. Can Med Assoc J, 1984, 131(12): 1461–1466.
8. Hodnett ED, Downe S, Edwards N, et al. Home-like versus conventional institutional settings for birth. Cochrane Database Syst Rev, 2005, (1): CD000012.
9. Eckert K, Turnbull D, MacLennan A. Immersion in water in the first stage of labor: a randomized controlled trial. Birth, 2001, 28(2): 84-93.
10. Cluett ER, Nikodem VC, McCandlish RE. Immersion in water in pregnancy, labour and birth. The Cochrane Database of Systematic Reviews 2006, Issue 4.
11. 董淑筠, 金皖玲, 程蔚蔚, 等. 水中分娩462例臨床分析. 上海醫學, 2005, 28(9): 737-740.
12. Liu EH. Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ, 2004, 328(7453): 1410.
13. Sharma SK, McIntire DD, Wiley J, et al. Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiology, 2004, 100(1): 142-148.
14. Somuah MA, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2006, Issue 4.
15. Turnbull D, Holmes A, Shields N, et al. Randomised, controlled trial of efficacy of midwife-managed care. Lancet, 1996, 348(9022): 213-218.
16. Stamp G, Kruzins G, Crowther C. Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. BMJ, 2001, 322(7297): 1277-1280.
17. 羅賢英, 吳莉娟, 包芳芳. 按摩會陰在分娩中的保護作用. 齊齊哈爾醫學院學報, 2002, 12(2): 143.
18. Hansen SL, Clark SL, Foster JC. Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol, 2002, 99(1): 29-34.
19. Simpson KR, James DC. Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial. Nurs Res, 2005, 54(3): 149-157.
20. Altman D, Ragnar I, Ekström A, et al. Anal sphincter lacerations and upright delivery postures--a risk analysis from a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct, 2007, 18(2): 141-146.
21. 歸亞峰. 坐式分娩與臥式分娩的對照研究. 中國初級衛生保健, 2005, 19(12): 46-47.
22. 季平, 趙曼林, 劉春燕, 等. 會陰側切術與會陰正中切術的臨床觀察. 國際醫藥衛生導報, 2006, 12(18): 27-28. 　.
23. Mayerhofer K, Bodner-Adler B, Bodner K, et al. Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1, 076 women. J Reprod Med, 2002, 47(6): 477-482.
24. McCandlish R, Bowler U, van Asten H, et al. A randomised controlled trial of care of the perineum during second stage of normal labour. Br J Obstet Gynaecol, 1998, 105(12): 1262-1272.
25. Weerasekera DS, Premaratne S. A randomised prospective trial of the obstetric forceps versus vacuum extraction using defined criteria. J Obstet Gynaecol, 2002, 22(4): 344-345.
26. 盧施吏. 陰部神經阻滯陰道擴張法在分娩中的應用. 中國社區醫師, 2005, 7(100): 21.
27. 楊華. 分娩時局部應用利多卡因對會陰的保護作用. 中國臨床醫生, 2002, 30(5): 43-44.
28. Leroux, Nathalie. Bujold, Emmanuel. Impact of chromic catgut versus polyglactin 910 versus fast-absorbing polyglactin 910 sutures for perineal repair: a randomized, controlled trial. American Journal of Obstetrics & Gynecology, 2006, 194(6): 1585-1590.
29. 胡葉平, 徐威萍. 兩種會陰切開縫合術比較. 實用醫學雜志, 2005, 21(18): 2041-2042.
30. Lundquist M, Olsson A, Nissen E. Is it necessary to suture all lacerations after a vaginal delivery? Birth, 2000, 27(2): 79-85.

《中國循證醫學雜志》

會陰保護的臨床證據

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會陰保護的臨床證據

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