镇痛分娩中胎儿窘迫相关因素分析

Related factors analysis of fetal distress in childbirth analgesia

目的分析镇痛分娩后出现胎儿窘迫的相关因素,提出在镇痛分娩时预防胎儿窘迫的措施。方法对2000年10月～2012年11月本院140例镇痛分娩后出现因胎心变异的胎儿窘迫与同期420例镇痛分娩后未出现异常的相关因素进行比较分析。结果两组间在宫缩间歇期注入麻醉药率分别为14.3%、59.0%,麻醉前空腹>4 h率分别为20.0%、2.4%,低血压期应用缩宫素静脉滴注加强宫缩率分别为21.4%、0.5%,差异有统计学意义(P<0.05)。两组间血压下降>30 mm Hg率分别为30.0%、14.8%,麻醉后采取平卧位控制阻滞平面率分别为30.0%、12.4%,差异有统计学意义(P<0.01)。结论麻醉前4 h内适量进食、宫缩节律的间歇期注入麻醉药物、减少血压下降幅度、低血压时不使用缩宫素、麻醉后采取侧卧位控制阻滞平面可有效预防镇痛分娩后因胎心变异发生的胎儿窘迫。

Objective To analyze the related factors of fetal distress on analgesia after childbirth,to put forward the preventive measures of fetal distress in childbirth analgesia.Methods The related factors of 140 cases of childbirth analgesia because of the variation of cardiac fetal distress from October 2000 to November 2012,and at the same time,420 cases of childbirth analgesia did not appear abnormal were analyzed.Results The uterine intermission injected anesthetics rates were 14.3%,59.0% among the two groups,preoperative fasting4 h rates were 20.0%,2.4%,application of oxytocin intravenous drip of hypotension stage to strengthen the contraction rate were 21.4%,0.5%,the difference was statistically significant（P 0.05）.Blood pressure between the two groups decreased 30 mm Hg rates were 30.0%,14.8%,take supine position after anesthesia control block plane rates were 30.0%,12.4%,the difference was statistically significant（P 0.01）.Conclusion Anesthesia intermittent period,eating the right amount of contraction before 4 h in jection of anesthetic drugs reduced blood pressure,slow decline,hypotension without using oxytocic to lateral control block plane can be effective preventive analgesia delivery for fetal heart variability in the occurrence of fetal distress after anesthesia.