双球囊导管用于足月妊娠促宫颈成熟及引产的临床观察

发布时间：2018-04-08 07:43

本文选题：双球囊导管　切入点：足月妊娠　出处：《大连医科大学》2014年硕士论文

【摘要】：目的:了解双球囊导管用于足月妊娠促宫颈成熟及引产的有效性、安全性和对产程的影响。方法:回顾性分析2012年7月～2013年5月在中国人民解放军第210医院住院分娩的初产妇594例，其中以双球囊导管促宫颈成熟及引产的产妇106例（DBC组），以控释地诺前列酮栓促宫颈成熟及引产的产妇104例（CRD组），自然临产并阴道分娩的产妇384例（对照组）；收集试验对象的宫颈评分变化、分娩方式、引产至临产时间、产程进展以及产后观察各项指标；采用独立样本t检验、单因素方差分析以及χ2检验，对上述指标进行统计学分析，并用Excel散点图拟合各种产程曲线，对双球囊导管促宫颈成熟及引产的有效性、安全性和对产程的影响进行分析评价，从而为产科临床提供良好的治疗方法。结果：一、双球囊导管促宫颈成熟及引产的有效性：1、宫颈评分：DBC组产妇放置双球囊导管前、后宫颈Bishop评分差异显著（p＜0.05）；DBC组产妇从放置至取出球囊宫颈Bishop评分平均提高2.70分，但与CRD组(均数2.72分)比较，差异不显著（p＞0.05）；2、分娩方式：DBC组和CRD组产妇分娩方式构成比差异显著（p＜0.05），DBC组产妇剖宫产率低于CRD组；3、改行剖宫产指征：产妇改行剖宫产指征按由高到低顺序，DBC组依次为：产程异常、社会因素、胎儿窘迫、引产失败；CRD组依次为：胎儿窘迫、产程异常、社会因素、引产失败,两组剖宫产指征构成比差异显著（p＜0.05），其中DBC组产妇以引产失败和胎儿窘迫为指征而改行剖宫产分娩的比例低于CRD组。二、双球囊导管促宫颈成熟及引产的安全性： CRD组经阴道分娩产妇产程中子宫强直收缩发生率为1.61%，其余两组均无子宫强直收缩病例发生；三组经阴道分娩产妇产后2小时出血量及产后尿潴留发生率比较，差异均不显著（p＞0.05）；三组阴道分娩的新生儿均无新生儿窒息病例发生。三、双球囊导管促宫颈成熟及引产对产程的影响：DBC组与对照组产妇比较，DBC组第一产程及总产程显著缩短（p＜0.05），第二、三产程与对照组比较无明显差异（p＞0.05），进一步分析表明，DBC组产妇第一产程的潜伏期较对照组显著缩短（p＜0.05），，而活跃期与对照组无明显差异（p＞0.05）；DBC组与CRD组产妇比较，第一、二、三产程及总产程均无显著差异（p＞0.05），进一步分析表明DBC组产妇第一产程的潜伏期较CRD组显著缩短（p＜0.05），活跃期长于CRD组（p＜0.05）。结论：双球囊导管用于足月妊娠促宫颈成熟及引产具有良好的临床效果，可显著改善宫颈条件，无药物引产的副作用，使用安全性较高，并可缩短产程，从而减轻了产妇对产痛的焦虑及体力消耗。因此，具有较好的临床推广应用价值。
[Abstract]:Objective: to investigate the efficacy, safety and effect of double balloon catheter on cervical maturation and labor induction in term pregnancy.Methods: from July 2012 to May 2013, 594 cases of primiparous delivery in the 210th Hospital of the Chinese people's Liberation Army were retrospectively analyzed.Among them, 106 cases were treated with double-balloon catheter to promote cervical maturation and induced labor, 104 cases were treated with controlled-release diloprostone suppository to promote cervical maturation and induced labor, 384 cases of spontaneous labor and vaginal delivery were collected (control group;The cervical score of the subjects,The methods of delivery, the time of induced labor to labor, the progress of labor and the indexes of postpartum observation were analyzed statistically by using independent sample t test, single factor analysis of variance and 蠂 2 test.All kinds of labor process curves were fitted with Excel scatter plot to analyze and evaluate the efficacy, safety and effect of double balloon catheter on cervix maturation and labor induction, so as to provide a good treatment method for obstetrical clinic.Results:The results were as follows: 1. The effectiveness of double balloon catheter in promoting cervical maturation and inducing labor was 1: 1. The cervical Bishop score increased by 2.70 points on average from the time of placement to the removal of balloon cervix, and the difference of cervical Bishop score between the two groups was significant (p < 0.05) before the placement of the double balloon catheter.But compared with the CRD group (mean 2.72),There was no significant difference (p > 0.05). There was a significant difference in the proportion of delivery mode composition between the two groups (P < 0.05). The rate of cesarean section in the CRD group was lower than that in the CRD group (P < 0.05), and the indication of cesarean section: the indication of cesarean section was abnormal in the order of high to low order.The social factors, fetal distress, induced labor failure and CRD group were fetal distress, abnormal labor process, social factors and induced labor failure.The ratio of indications of cesarean section was significantly different between the two groups (p < 0.05). In DBC group, the rate of cesarean section delivery was lower than that in CRD group, which was indicated by induced abortion and fetal distress.2. The safety of double balloon catheter in promoting cervix maturation and induced labor: the incidence of uterine ankylosis contraction in CRD group was 1.61g during the parturition, and there were no cases of uterine ankylosis contraction in the other two groups.There was no significant difference in the rate of postpartum blood loss and postpartum urinary retention among the three groups, and there was no neonatal asphyxia in the three groups.The effect of double balloon catheter on the labor process of cervix maturation and induction of labor the first stage and total stage of labor in the DBC group were significantly shorter than those in the control group (P < 0.05), and the second, the first stage of labor and the total stage of labor in the DBC group were significantly shorter than those in the control group (P < 0.05).There was no significant difference between the three stages of labor and the control group (p > 0.05). Further analysis showed that the latency of the first stage of labor in the DBC group was significantly shorter than that in the control group (p < 0.05), but there was no significant difference between the active period and the control group (p > 0.05).There was no significant difference between the three stages of labor and the total stage of labor (p > 0.05). Further analysis showed that the latency of the first stage of labor in the DBC group was significantly shorter than that in the CRD group (P < 0.05), and the active period was longer than that in the CRD group (p < 0.05).Conclusion: double balloon catheter has a good clinical effect in promoting cervical maturation and induced labor in term pregnancy. It can significantly improve the cervical condition, have no side effect of drug induced labor, be used safely, and shorten the labor process.As a result, the parturient's anxiety about labor pain and physical exertion were alleviated.Therefore, it has good clinical application value.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R719.3

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