应用间苯三酚治疗产程活跃期宫颈水肿的临床观察

Clinical observation of the treatment of cervical edema during the active phase of labor using phloroglucinol

目的观察产程活跃期伴有宫颈水肿时,静脉分别注射间苯三酚、地西泮与山茛菪碱等常用宫颈解痉药物在加速产程进展方面的影响及用药后对母儿安全性的影响。方法选取2013年6月至2014年2月在上海市第七人民医院产科住院待产、足月、单胎头位初产妇147例,宫口开大3 cm后宫颈出现痉挛、水肿,且无妊娠期合并症及产科并发症,将其随机分为A、B、C 3组。A组(49例)静脉注射间苯三酚80 mg;B组(52例)静脉缓慢注射地西泮10 mg(>5 min);C组(46例)静脉缓慢注射山茛菪碱10 mg,观察记录3组产妇的宫口扩张速度、产程进展情况、分娩结局、新生儿Apgar评分、产后2 h内出血量及药物不良反应。结果A组从用药至宫口开全(10 cm)时间为(199±44)min,产程时间少于B组与C组(P<0.05);3组新生儿Apgar评分、产后2 h内出血量、分娩结局比较差异无统计学意义(P>0.05)。A组用药后母儿未发现药物不良反应。结论产程活跃期宫颈水肿应用间苯三酚可有效消除宫颈痉挛水肿,加速宫颈扩张,加速产程进展,临床疗效优于地西泮与山茛菪碱,用药安全,母儿无不良反应,可在产科临床上推广应用。

Objective To observe the effect and safety of phloroglucinol,diazepam and anisodamine in alleviating cervical edema and promoting the labor progress during active phase of labor. Methods 147 full term primipara with single pregnancy and head position in Shanghai Seventh People’s Hospital from July 2013 to February 2014 were collected,all cases developed cervical spasm or cervical edema after cervical dilatation≥3 cm. All cases were randomly divided into A,B,C groups. Group A（ n = 49） was treated with phloroglucinol 80 mg; Group B（ n = 52） was treated with diazepam 10 mg by intravenous injection（ 〉 5min）; Group C（ n = 46）was treated with anisodamine 10 mg by intravenous injection. The labor progress,delivery mode,Apgar scores of newborns,postpartum hemorrhage（ 〈 2 h） and the adverse reaction of medicine of three groups were observed. Results The duration from drug administration to full dilation of the cervix in group A was（ 199 ± 44） min,which was significantly shorter than group B and group C（ P 〈 0. 05）. No statistically difference was found in the Apgar scores of newborns,postpartum hemorrhage（ 〈 2 h）,delivery mode（ P〉 0. 05）,and no adverse reaction was found in group A. Conclusion Using phloroglucinol can effectively improve cervical dilatation,shorten the labor course without adverse effect. The effect of phloroglucinol is better than diazepam and anisodamine,and it is worthy of further clinical application.