基于实施性研究综合框架的正常分娩中非必要干预实施的影响因素：一项质性研究

doi:10.12114/j.issn.1007-9572.2025.0343

中国全科医学 ›› 2026, Vol. 29 ›› Issue (35): 5235-5241.DOI: 10.12114/j.issn.1007-9572.2025.0343

基于实施性研究综合框架的正常分娩中非必要干预实施的影响因素：一项质性研究

赵阳¹, 杨颖², 刘玉³, 高冰洁⁴, 梅娜⁴, 尹雪梅⁵^,^*()

1．300070　天津市，天津医科大学护理学院
2．300020　天津市，中国医学科学院血液病医院　中国医学科学院血液学研究所
3．300211　天津市，天津医科大学第二医院妇科
4．300199　天津市中心妇产科医院产科
5．300199　天津市中心妇产科医院护理部

收稿日期:2025-07-13 修回日期:2025-12-16 出版日期:2026-12-15 发布日期:2026-10-26
通讯作者: 尹雪梅
作者贡献：
赵阳负责研究的构思与设计，撰写论文；杨颖、刘玉、高冰洁、梅娜负责研究的实施，资料的收集、整理和分析；赵阳、杨颖、尹雪梅负责结果分析和解释；尹雪梅负责研究实施的质量控制，论文最终版修订，对文章整体负责。
基金资助:
天津市教委科研计划项目(2022SK207)

Research on Influencing Factors of Implementation of Unnecessary Interventions during Normal Childbirth Based on the Consolidated Framework for Implementation Research: a Qualitative Study

ZHAO Yang¹, YANG Ying², LIU Yu³, GAO Bingjie⁴, MEI Na⁴, YIN Xuemei⁵^,^*()

1. School of Nursing, Tianjin Medical University, Tianjin 300070, China
2. Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin 300020, China
3. Department of Gynecology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
4. Department of Obstetrics, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300199, China
5. Nursing Department, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300199, China

Received:2025-07-13 Revised:2025-12-16 Published:2026-12-15 Online:2026-10-26
Contact: YIN Xuemei

摘要/Abstract

摘要： 背景正常分娩中非必要干预的实施严重制约了正常分娩的规范、有效开展，造成医疗资源浪费，阻碍了母婴健康水平的提升，目前尚缺乏对其影响因素的全面探索。目的基于实施性研究综合框架（CFIR）分析正常分娩中非必要干预实施的影响因素，为推动正常分娩的规范开展提供参考。方法采用目的抽样法，于2023年12月—2024年2月选取天津市中心妇产科医院和天津医科大学第二医院的15名助产士为研究对象。采用质性研究方法，基于CFIR制定访谈提纲，对助产士进行半结构式访谈，采用主题分析法进行资料分析。结果基于CFIR共识别出影响正常分娩中非必要干预实施的4个促进因素（领导力主导、质量控制规范、分娩相关指南和大众媒体正向宣传）、3个阻碍因素（实施者的旧观念和习惯、孕产妇产力不足和助产人力资源不足）和4个中性因素（干预的作用、多方共同决策、以孕产妇为中心的理念和孕产妇需求评估）。结论正常分娩中非必要干预的实施受多种因素的影响，需重点关注其中的促进和阻碍因素，可通过发挥领导力的牵引带动作用、推动分娩指南转化应用、宣传传播正确的分娩干预、严格落实质量控制规范、积极应对产力不足、更新助产观念和习惯以及强化助产人力管理，解决过多的分娩干预问题，推动正常分娩的规范化开展，提高分娩服务质量，提升母婴健康水平。

关键词: 分娩, 非必要干预, 实施性研究综合框架, 影响因素分析, 质性研究

Abstract:

Background

Unnecessary interventions impeded the standardized practices during normal childbirth, and therefore caused unfavorable health outcome in mothers and their babies as well as waste of medical resources. There is a lack of comprehensive exploration of its influencing factors.

Objective

To explore factors influencing implementation of unnecessary interventions during normal childbirth. And thereby provide references for promoting the standardized practices of normal childbirth.

Methods

The qualitative methodology was utilized. Based on the Consolidated Framework for Implementation Research (CFIR), we developed the interview outline and performed semi-structured interviews with fifteen midwives in Tianjin Central Hospital of Gynecology Obstetrics and The Second Hospital of Tianjin Medical University. Thematic analysis was undertaken to analyze data.

Results

Based on the CFIR, a total of four facilitators (leadership, quality control standards, childbirth guidelines and positive publicity by mass media), three barriers (old concepts and habits of implementers, decreased expulsive force, and midwifery shortage) and four neutral factors (effects of interventions, shared decision-making of multiple stakeholders, women-centered philosophy and assessment of maternal needs) were identified as influencing the implementation of unnecessary interventions during normal childbirth.

Conclusion

Implementation of unnecessary interventions during normal childbirth is influenced by various factors. Attention should be paid to the facilitators and barriers, and address the issue of excessive interventions during normal childbirth through leveraging leadership as a strategic driver, promoting the application of guidelines on childbirth, publicizing and disseminating correct childbirth interventions, strictly implementing quality control standards, actively dealing with women's decreased expulsive force, updating midwives' concepts and habits, and solving the shortage of midwifery workforce, and therefore improve the services of maternal and neonatal health as well as achieve better health outcomes.

Key words: Parturition, Unnecessary intervention, Consolidated Framework for Implementation Research, Root cause analysis, Qualitative research

中图分类号:

R 714.3

赵阳,杨颖,刘玉,等. 基于实施性研究综合框架的正常分娩中非必要干预实施的影响因素：一项质性研究[J]. 中国全科医学, 2026, 29(35): 5235-5241. DOI: 10.12114/j.issn.1007-9572.2025.0343.
ZHAO Yang,YANG Ying,LIU Yu, et al. Research on Influencing Factors of Implementation of Unnecessary Interventions during Normal Childbirth Based on the Consolidated Framework for Implementation Research: a Qualitative Study[J]. Chinese General Practice, 2026, 29(35): 5235-5241. DOI: 10.12114/j.issn.1007-9572.2025.0343.

图/表 1

参考文献 32

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领域	问题
创新	在正常分娩过程中，您如何实施氯己定消毒会阴、刮除会阴阴毛、人工破膜、灌肠、腹部宫底加压、静脉补液（缩短产程）、会阴侧切、吸引新生儿口鼻、第三产程按摩子宫、持续胎心监护、预防性使用抗生素？实施这些干预的决策者和实施者是谁？您认为这些干预有哪些作用（比如在母婴健康、产妇满意度等方面）？
外部因素	您认为哪些外部因素（比如政策、法规、指南等）会影响这些干预的实施？您对其他医院这些干预的实施情况有哪些了解？这些了解如何影响您的临床实践？
内部因素	您认为哪些内部因素（比如设备设施、科室氛围等）会影响这些干预的实施？
个体	关于循证指南对于这些干预的推荐意见您有哪些了解？您如何看待非必要干预的实施情况？
实施过程	您认为改变这些干预实施的必要性如何？如有必要，如何改变？改变的难易度如何？

领域	问题
创新	在正常分娩过程中，您如何实施氯己定消毒会阴、刮除会阴阴毛、人工破膜、灌肠、腹部宫底加压、静脉补液（缩短产程）、会阴侧切、吸引新生儿口鼻、第三产程按摩子宫、持续胎心监护、预防性使用抗生素？实施这些干预的决策者和实施者是谁？您认为这些干预有哪些作用（比如在母婴健康、产妇满意度等方面）？
外部因素	您认为哪些外部因素（比如政策、法规、指南等）会影响这些干预的实施？您对其他医院这些干预的实施情况有哪些了解？这些了解如何影响您的临床实践？
内部因素	您认为哪些内部因素（比如设备设施、科室氛围等）会影响这些干预的实施？
个体	关于循证指南对于这些干预的推荐意见您有哪些了解？您如何看待非必要干预的实施情况？
实施过程	您认为改变这些干预实施的必要性如何？如有必要，如何改变？改变的难易度如何？

基于实施性研究综合框架的正常分娩中非必要干预实施的影响因素：一项质性研究

Research on Influencing Factors of Implementation of Unnecessary Interventions during Normal Childbirth Based on the Consolidated Framework for Implementation Research: a Qualitative Study

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