摘要
目的:探究分娩镇痛对单胎子痫前期产妇平均动脉压(MAP)、外周血管阻力(SVR)、产程及不良妊娠结局的影响。方法:将本院2017年2月—2019年10月收治的107例单胎子痫前期患者纳为观察对象,根据患者意愿分为镇痛组(硬膜外自控镇痛,n=67)与非镇痛组(不使用镇痛药物,n=40),分别监测两组临产时(T0)、潜伏期(宫口>1cm,T1)、活跃期(宫口>3cm,T2)、活跃期1h(T3)、宫口全开(T4)时产妇平均动脉压(MAP)、外周血管阻力(SVR)、心输出量(CO)水平,并记录两组产程及不良妊娠结局。结果:非镇痛组T0、T1、T2、T3、T4过程中MAP、SVR及CO水平均维持较高水平,无显著性波动(P>0.05),镇痛组T2、T3、T4时MAP、SVR及CO均较T0时降低(P<0.05),且低于同期非镇痛组(均P<0.05);第一产程镇痛组(144.15±35.59mm)短于非镇痛组(198.15±41.15mm),第二产程镇痛组(46.15±6.47mm)长于非镇痛组(37.15±7.44mm)(P<0.05);镇痛组产妇平产率(80.6%)高于非镇痛组(60.0%),产钳助产率(16.4%)低于非镇痛组(35.0%)(均P<0.05),两组中转剖宫产率无差异(P>0.05);镇痛组宫缩素使用率(74.6%)高于非镇痛组(32.5%),降压药使用率(29.9%)低于非镇痛组(65.0%),VAS评分(2.37±0.68分)低于非镇痛组(7.45±1.24分)(均P<0.05);两组产后出血、新生儿窒息、胎儿窘迫发生率,以及新生儿1min及5min Apgar评分均无差异(均P>0.05)。结论:分娩镇痛能有效改善子痫前期产妇血流动力学状态,降低阴道试产危险性,提高平产率,更好保障母婴安全。
Objective:To study the effect of labor analgesia of women with singleton and preeclampsia on their values of the mean arterial pressure(MAP)and systemic vascular resistance(SVR),situation of stages of labor,and rate of adverse pregnancy outcomes.Methods:109 women with singleton and preeclampsia were included and were divided into two groups according to their wiliness from February 2017 to October 2019,and 67 women in study group had received epidural controlled analgesia and 40 women in control group hadn’t received analgesia.The values of MAP,SVR,and cardiac output(CO)of women in both groups when near the time of labour(T0),uterus opening over 1cm(T1),uterus opening over 3cm(T2),within 1h after uterus opening over 3cm(T3),and fully dilated cervix(T4)were recorded.The situation of stages of labor,and adverse pregnancy outcomes of women in the two groups were recorded.Results:In the control group,the values of MAP,SVR and CO of women at T0,T1,T2,T3 and T4 had remained high level without significant fluctuation(P>0.05).The values of MAP,SVR and CO of women in the study group at T2,T3 and T4 were significantly lower than those at T0(P<0.05),and those of women in the study group at T0,T1,T2,T3 and T4 were significant lower than those of women in the control group(P<0.05).The first stage of labor of women in the study group(144.15±35.59mm)was significant shorter than that(198.15±41.15mm)of women in the control group,and the second stage of labor of women in the study group(46.15±6.47mm)was significant longer than that(37.15±7.44mm)of women in the control group(P<0.05).The normal birth rate(80.6%)of women in the study group was significant higher than that(60.0%)of women in the control group,and the delivery rate by obstetric forceps(16.4%)of women in the study group was significant lower than that(35.0%)of women in the control group(all P<0.05).There was no difference in cesarean section rate of women between the two groups(P>0.05).The rate of oxytocin used of women in the study group(74.6%)was significant higher than that(32.5%)of women in the control group,the rate of antihypertensive drugs used of women in the study group(29.9%)was significant lower than that(65.0%)of women in the control group,and the VAS score of women in the study group(2.37±0.68 points)was significant lower than that(7.45±1.24 points)of women in the control group(all P<0.05).There were no significant different in the incidences of postpartum hemorrhage,neonatal asphyxia,and fetal distress,and 1 min and 5 min Apgar score of newborn between the two groups(P>0.05).Conclusion:Labor analgesia can effectively improve hemodynamic state of women with preeclampsia,reduce the risk of vaginal delivery,increase the rate of vaginal delivery,and ensure the safety of mom and infant.
作者
侯爱琴
闫真
王宝兰
张媛媛
李彦荣
HOU Aiqin;YAN Zhen;WANG Baolan;ZHANG Yuanyuan;LI Yanrong(Affiliated Hospital of Yan'an University, Shaanxi Province, 716000)
出处
《中国计划生育学杂志》
2020年第12期2013-2016,共4页
Chinese Journal of Family Planning
关键词
单胎
子痫前期
分娩镇痛
平均动脉压
外周血管阻力
产程
妊娠结局
Singleton
Preeclampsia
Labor analgesia
Mean arterial pressure
Systemic vascular resistance
Stages of labor
Pregnancy outcomes
