目的：探讨改良 HELPERR程序预防肩难产致新生儿产伤及对产妇身心状况的影响。方法选择2010年1月～2011年7月我科收治的175例肩难产产妇设为对照组，采取常规 HELPERR程序助产接生；选取2013年1月～2014年7月收治的184例肩难产产妇设为研究组，采取改良 HELPERR程序应用于阴道分娩全程。比较两组新生儿产伤、产后并发症发生率、产后抑郁症发生率及满意度。结果研究组窒息、骨骼损伤、臂丛神经损伤及胸锁乳突肌血肿发生率均低于对照组，有显著性差异（P＜0．05）。产后出血、产道损伤、产褥感染及耻骨联合分离发生率低于对照组，有显著性差异（P＜0．05）。研究组产褥期抑郁症发生率低于对照组，有显著性差异（P＜0．05）。研究组满意度高于对照组，有显著性差异（P＜0．05）。结论改良 HELPERR程序能降低肩难产致新生儿产伤及产妇并发症发生率，同时还能提高产妇心理舒适度，降低产后抑郁症发生率，取得较为满意的临床效果。%Objective To explore the modified HELPERR procedures to prevent the shoulder dystocia and neonatal birth and impact on the physical and mental status of pregnant women ,and for high risk parturient shoulder dystocia optimization scheme of evidence-based data accumulation .Methods A retrospective analysis of 175 cases of maternal shoulder dystocia in our hospital in 2010 January ~2011 year in July obstetrics were set as control group ,take ,conventional HELPERR pro‐gram development of midwifery delivery ;184 cases of shoulder selects my courtyard in 2013 January ~2014 year in July ob‐stetrics from dystocia maternal ,set as study group ,to adopt a modified HELPERR procedure applied to the whole process of vaginal delivery .Recorded the incidence of two groups of neonatal and maternal complications ,and two groups were com‐pared with the incidence of postpartum depression and satisfaction .Results The study group of asphyxia ,skeletal injury , injury of brachial plexus nerve and sternocleidomastoid hematoma incidence was lower than the control group ,the difference was statistically significant (P<0 .05) .Research group of postpartum hemorrhage ,injury of birth canal ,puerperal infection and the incidence of pubic symphysis separation were lower than the control group ,the difference was statistically significant (P<0 .05) .Research group of puerperal depression incidence rate of 4 .3% ,lower than the 12 .0% in the control group ,the difference was statistically significant (P<0 .05) .Research on the satisfaction degree of group was 97 .3% ,higher than 83 . 4% in the control group ,the difference was statistically significant (P<0 .05) .Conclusion The modified HELPERR proce‐dure can reduce the shoulder dystocia and neonatal birth and maternal complications incidence rate ,but also can improve ma‐ternal psychological comfort ,reduce the incidence of postpartum depression ,achieved satisfactory clinical results .
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