会阴保护的临床证据_《中国循证医学杂志》

作者：

程萌 ,  许良智

四川大学华西第二医院妇产科（成都?610041）;

关键词：

会阴保护临床证据系统评价随机对照试验

DOI：

10.7507/1672-2531.20080151

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

会阴保护是产科的一个经典问题，从古至今，人们一直在进行各种尝试和摸索，既总结出一套有效的保护方法又在此方面进行了新的尝试。如何评价这些方法的有效性和可靠性呢？为此笔者检索了Cochrane图书馆（2007年第3期）、MEDLINE（1980.1～2007.5）和中国生物医学文献数据库（1980.1～2007.5），收集关于会阴按摩、会阴切开、分娩镇痛等会阴保护方面的系统评价和随机对照试验，对其进行归纳总结，以求为临床工作实践提供最佳的依据。

引用本文： 程萌,许良智. 会阴保护的临床证据. 中国循证医学杂志, 2008, 08(8): 673-677. doi: 10.7507/1672-2531.20080151 复制

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.	徐小卫. 妊娠晚期会阴按摩预防产时会阴损伤的临床观察. 浙江临床医学, 2003, 5(2): 93-95.
4.	王安英. 孕晚期会阴按摩预防产时会阴损伤的疗效观察. 中国妇幼保健, 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例临床分析. 上海医学, 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.	罗贤英, 吴莉娟, 包芳芳. 按摩会阴在分娩中的保护作用. 齐齐哈尔医学院学报, 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.	归亚峰. 坐式分娩与卧式分娩的对照研究. 中国初级卫生保健, 2005, 19(12): 46-47.
22.	季平, 赵曼林, 刘春燕, 等. 会阴侧切术与会阴正中切术的临床观察. 国际医药卫生导报, 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.	卢施吏. 阴部神经阻滞阴道扩张法在分娩中的应用. 中国社区医师, 2005, 7(100): 21.
27.	杨华. 分娩时局部应用利多卡因对会阴的保护作用. 中国临床医生, 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.	胡叶平, 徐威萍. 两种会阴切开缝合术比较. 实用医学杂志, 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. 徐小卫. 妊娠晚期会阴按摩预防产时会阴损伤的临床观察. 浙江临床医学, 2003, 5(2): 93-95.
4. 王安英. 孕晚期会阴按摩预防产时会阴损伤的疗效观察. 中国妇幼保健, 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例临床分析. 上海医学, 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. 罗贤英, 吴莉娟, 包芳芳. 按摩会阴在分娩中的保护作用. 齐齐哈尔医学院学报, 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. 归亚峰. 坐式分娩与卧式分娩的对照研究. 中国初级卫生保健, 2005, 19(12): 46-47.
22. 季平, 赵曼林, 刘春燕, 等. 会阴侧切术与会阴正中切术的临床观察. 国际医药卫生导报, 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. 卢施吏. 阴部神经阻滞阴道扩张法在分娩中的应用. 中国社区医师, 2005, 7(100): 21.
27. 杨华. 分娩时局部应用利多卡因对会阴的保护作用. 中国临床医生, 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. 胡叶平, 徐威萍. 两种会阴切开缝合术比较. 实用医学杂志, 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.

《中国循证医学杂志》

会阴保护的临床证据

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《中国循证医学杂志》

会阴保护的临床证据

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