SECOND STAGE LABOR NURSING CARE WITH EPIDURAL ANESTHESIA

硬膜外麻醉在分娩镇痛中的应用 在全美被广泛接受，报告的患病率 对于许多医院来说，这一比例高达98%。然而，研究的匮乏 已经报道了第二阶段分娩护理标准是如何 基于非麻醉药使用的通用管理指南 应根据援助等干预措施对妇女进行调整 有承重或推动的努力、定位和休息时间的 妇女接受硬膜外麻醉的间隔时间。因为这个趋势 预测在产程中硬膜外麻醉的使用 要继续下去，跨学科护理和医学研究是必要的。 提供数据，以用于制定第二种疾病的护理指南 生产阶段：1)定义可接受的长度和参数 进展；2)降低胎儿/新生儿不良结局的风险；3) 减少母体疲劳和会损伤；4)减少发生率 没有进步，母亲疲惫/精疲力竭和胎儿 宫内窘迫可作为器质性/辅助性或剖腹产的指征 分娩；以及5)提高产妇对分娩的满意度 经验。这项研究的目的是确定是否存在差异 基于休息和休息的母婴和新生儿结局 第二产程与第二产程的护理方案比较 “标准”护理规程。此外，有关这一关系的数据 麻醉开始和持续时间、产妇体位和推力/休息 指定的孕产妇和胎儿/新生儿结局的模式为 获得。随机对照实验设计将被用于 研究对象分劳务单位和分娩单位两个。基于电力 分析计算，总计630名未分娩妇女的样本将 招募并随机分为对照组(n=315)或 实验组(315例)。测试的分析程序 具有统计学意义的组差异将包括组合 频数/贝叶斯，卡方，多元回归，Logistic 回归和对数线性分析程序。

The use of epidural anesthesia for pain control in labor and delivery is widely accepted throughout the U.S. with prevalence rates reported for many hospitals as high as 98 percent. However, a paucity of research has been reported on how standards for second stage labor care that are based on the common management guidelines used for non-anesthetized women, should be adapted in relation to interventions such as assistance with bearing-down or pushing efforts, positioning, and resting time intervals for women receiving epidural anesthesia. Since the trend toward use of epidural anesthesia during the intrapartum is predicted to continue, interdisciplinary nursing and medical research is necessary to provide data to use in developing care guidelines for the second stage of labor that: 1) define acceptable parameters for length and progress; 2) reduce the risk for adverse fetal/neonatal outcomes; 3) minimize maternal fatigue and perineal trauma; 4) reduce the incidence of failure to progress , maternal fatigue/exhaustion and fetal distress as indications for instrumental/assisted or cesarean deliveries; and 5) promote maternal satisfaction with the childbirth experience. The study aims are to determine if there is a difference in maternal, fetal and neonatal outcomes based on the use of a rest and descend nursing care protocol for second stage labor versus a "standard" nursing care protocol. In addition, data on the relationship of anesthesia outset and duration, maternal positions, and pushing/rest patterns to the designated maternal and fetal/neonatal outcomes will be obtained. A randomized, controlled experimental design will be used to study the research aims in two labor and delivery units. Based on power analysis calculations, a total sample of 630 nulliparous women will be recruited and randomized into either the control group (n=315) or experimental group (n=315). Analysis procedures for testing statistically significant group differences will include a combination of Frequentist/Bayesian, Chi-square, multiple regression, logistic regression and loglinear analysis procedures.