中国妇幼保健

目的 探讨渐进式肌肉放松疗法联合椎管内镇痛对初产妇分娩恐惧及妊娠结局的影响。方法 选取2024年11月—2025年3月在温州医科大学附属第二医院分娩的初产妇180例，按照随机数字表法将其分为镇痛组(常规干预+椎管内镇痛)和肌肉放松组(渐进式肌肉放松疗法联合椎管内镇痛)，每组90例。比较两组初产妇分娩恐惧、自我效能、产程进展、分娩方式及妊娠结局。结果 干预前，两组初产妇的分娩恐惧评分相似(P>0.05);干预后，两组初产妇的分娩恐惧评分均下降，且肌肉放松组初产妇的孩子健康(7.25±1.07)分、疼痛伤害(6.62±1.09)分、分娩失控(5.87±1.26)分、医疗环境(5.57±1.04)分低于镇痛组初产妇的孩子健康(7.69±1.24)分、疼痛伤害(7.05±1.34)分、分娩失控(6.32±1.05)分、医疗环境(6.01±1.28)分(均P<0.05)。干预前，两组初产妇的自我效能评分相似(P>0.05);干预后，两组初产妇的自我效能评分均提高，且肌肉放松组初产妇的结果效能(119.63±12.84)分、期望效能(126.57±14.29)分高于镇痛组初产妇的结果效能(114.85±13.67)分、期望效能(121.64±13.58)分(均P<0.05)。肌肉放松组初产妇的第一产程(6.64±2.07) h、第二产程(1.46±0.47) h、第三产程(5.61±1.25) min均短于镇痛组初产妇的第一产程(7.38±2.14) h、第二产程(1.64±0.58) h、第三产程(6.27±1.33) min(均P<0.05)。肌肉放松组初产妇的顺产率(88.89%)高于镇痛组初产妇的顺产率(54.44%)，阴道助产率(4.44%)、侧切率(4.44%)、顺转剖率(2.22%)低于镇痛组初产妇的阴道助产率(16.67%)、侧切率(15.56%)、顺转剖率(13.33%)，组间比较差异均有统计学意义(均P<0.05)。肌肉放松组初产妇的不良妊娠结局发生率(2.22%)低于镇痛组初产妇的不良妊娠结局发生率(12.22%)，组间比较差异有统计学意义(χ²=6.716,P<0.05)。结论 渐进式肌肉放松疗法联合椎管内镇痛能显著缓解初产妇分娩恐惧，提升自我效能;有效缩短产程，提高顺产率，降低各类干预率;减少不良妊娠结局发生，从心理、生理多方面优化分娩体验与妊娠结果，为初产妇带来积极影响。

Objective To explore the effect of progressive muscle relaxation therapy combined with intraspinal analgesia on childbirth fear and pregnancy outcomes in primiparas. Methods A total of 180 primiparas who delivered in the Second Affiliated Hospital of Wenzhou Medical University from November 2024 to March 2025 were selected and divided into the analgesia group(routine intervention + intraspinal analgesia) and the muscle relaxation group(progressive muscle relaxation therapy combined with intraspinal analgesia) using the random number table method,with 90 cases in each group. The childbirth fear,self-efficacy,labor progress,delivery mode and pregnancy outcomes were compared between the two groups. Results Before intervention,there was no significant difference in the childbirth fear scores between the two groups(P>0. 05). After intervention,the childbirth fear scores of both groups decreased,and the scores of child health(7. 25±1. 07),pain injury(6. 62±1. 09),loss of labor control(5. 87±1. 26) and medical environment(5. 57±1. 04) in the muscle relaxation group were lower than those in the analgesia group(7. 69± 1. 24,7. 05± 1. 34,6. 32± 1. 05 and 6. 01± 1. 28,respectively)(all P<0. 05). Before intervention,the self-efficacy scores of the two groups were similar(P > 0. 05). After intervention,the self-efficacy scores of both groups increased,and the scores of outcome efficacy(119. 63±12. 84) and expectancy efficacy(126. 57±14. 29) in the muscle relaxation group were higher than those in the analgesia group(114. 85±13. 67 and 121. 64±13. 58,respectively)(all P<0. 05). The first stage of labor(6. 64±2. 07 h),the second stage of labor(1. 46±0. 47 h) and the third stage of labor(5. 61±1. 25 min) in the muscle relaxation group were shorter than those in the analgesia group(7. 38±2. 14 h,1. 64±0. 58 h and 6. 27±1. 33 min,respectively)(all P<0. 05). The vaginal delivery rate in the muscle relaxation group(88. 89%) was higher than that in the analgesia group(54. 44%),while the vaginal assisted delivery rate(4. 44%),episiotomy rate(4. 44%) and rate of conversion from vaginal delivery to cesarean section(2. 22%) were lower than those in the analgesia group(16. 67%,15. 56% and 13. 33%,respectively),with statistically significant differences between the two groups(all P < 0. 05). The incidence of adverse pregnancy outcomes in the muscle relaxation group(2. 22%) was lower than that in the analgesia group(12. 22%), with a statistically significant difference(χ²= 6. 716,P < 0. 05). Conclusion Progressive muscle relaxation therapy combined with intraspinal analgesia can significantly relieve childbirth fear and improve self-efficacy in primiparas,effectively shorten the labor process,increase the vaginal delivery rate and reduce various intervention rates,as well as decrease the incidence of adverse pregnancy outcomes. It optimizes the childbirth experience and pregnancy results from both psychological and physiological aspects,exerting a positive effect on primiparas.