全产程分娩镇痛与第一产程分娩镇痛对妊娠高血压综合征产妇产程的影响

发布时间：2018-04-01 08:12

本文选题：妊娠高血压综合征　切入点：分娩镇痛　出处：《临床麻醉学杂志》2017年02期

【摘要】：目的比较全产程分娩镇痛与第一产程分娩镇痛用于合并妊娠高血压综合征产妇的安全性及有效性。方法选择2015年3~11月于北京妇产医院分娩的产妇196例,年龄22~35岁,ASAⅠ或Ⅱ级。所有产妇均为初产、单胎和足月妊娠,诊断妊娠高血压综合征。随机将入选产妇分为全产程分娩镇痛组(T组)和第一产程活跃期分娩镇痛组(F组)。T组在出现子宫规律收缩后进行分娩镇痛,持续应用镇痛泵至第三产程结束;F组在出现子宫规律收缩且进入第一产程活跃期(子宫口开至3cm)后进行分娩镇痛,子宫口开全后,由生理盐水代替泵内麻醉药物至第三产程结束。记录镇痛前、镇痛后10、60min、宫口开全、第二产程屏气用力和胎头娩出时的MAP和VAS评分;记录应用缩宫素例数和第二产程屏气用力时Bromage评分;记录第一、第二、第三产程时间、分娩方式、子痫和产后出血情况。结果第二产程屏气用力时,T组MAP明显低于F组[(106.0±7.0)mm Hg vs.(115.4±7.3)mm Hg,P0.05],VAS评分明显低于F组[(2.0±1.1)分vs.(5.1±1.2)分,P0.05];胎头娩出时,T组MAP明显低于F组[(106.2±7.2)mm Hg vs.(116.0±7.6)mm Hg,P0.05],VAS评分明显低于F组[(1.9±1.2)分vs.(5.2±1.3)分,P0.05];T组应用缩宫素例数明显多于F组[50(51%)vs.35(35%),P0.05]。两组Bromage评分、产程时间、分娩方式和相关不良反应差异无统计学意义。结论全产程分娩镇痛可安全有效地应用于合并妊娠高血压综合征的产妇。
[Abstract]:Objective to compare the safety and efficacy of full labor analgesia and first stage labor analgesia in pregnant women with pregnancy-induced hypertension syndrome (PIH). Methods 196 cases of parturient delivered in Beijing Maternity Hospital from March to November 2015 were selected. All parturients were first born, single and full-term. To diagnose pregnancy-induced hypertension syndrome, parturient were randomly divided into total labor analgesia group (group T) and first stage active labor analgesia group (group F). Group T was given labor analgesia after regular uterine contraction. Continuous use of analgesic pump to the end of the third stage of labor in group F after the occurrence of regular uterine contraction and entered the first active stage of labor (uterine opening to 3 cm) for labor analgesia, after the opening of the uterine mouth, The anesthetic was replaced by normal saline to the end of the third stage of labor. The MAP and VAS scores at the time of delivery of fetal head were recorded before analgesia, 1060 minutes after analgesia, total opening of uterine mouth, breath-holding force in the second stage of labor, and VAS score at the time of delivery of fetal head. To record the number of cases of oxytocin and the Bromage score of the second stage of breath holding, to record the time of the first, second and third stages of labor, and to record the mode of delivery. Results MAP in group T was significantly lower than that in group F [106.0 卤7.0)mm Hg vs.(115.4 卤7.3)mm HgG P 0.05] and MAP in group T was significantly lower than that in group F (2.0 卤1.1) vs.(5.1 卤1.2 at the time of delivery of fetal head (106.2 卤7.2)mm Hg vs.(116.0 卤7.6)mm HgG P 0.05), and that in group T was significantly lower than that in group F [106.2 卤7.2)mm Hg vs.(116.0 卤7.6)mm HgG P 0.05] when the second stage of labor was breath-holding, the score of MAP in group T was significantly lower than that in group F [106.0 卤7.0)mm Hg vs.(115.4 卤7.3)mm vs.(115.4 卤7.3)mm HgG P 0.05]. In group F (1.9 卤1.2) vs.(5.2 卤1.3), the number of cases of oxytocin used in group T was significantly higher than that in group F [50 / 51 vs 35 / 35]. The Bromage score of the two groups was significantly higher than that of the control group (P < 0.05). There was no significant difference in labor duration, delivery mode and related adverse reactions. Conclusion full labor analgesia can be used safely and effectively in pregnant women with pregnancy-induced hypertension syndrome.
【作者单位】：首都医科大学附属北京妇产医院麻醉科;
【基金】：北京市卫生和计划生育委员会科技成果和适宜技术推广项目(TG-2014-12)
【分类号】：R714.3

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