生物节律对初产妇分娩方案、镇痛效果及母婴结局的影响

Influence of biological rhythm on primiparas delivery plan,analgesic effect and mother-infant outcomes

目的 探讨生物节律对初产妇分娩方案、镇痛效果及母婴结局的影响。方法 将准备阴道分娩的100例产妇根据阵痛开始的时间分为白天组58例和夜晚组42例。对产妇蛛网膜下腔、硬膜外腔给予联合阻滞麻醉。L2~3或L3~4间隙成功穿刺后,向产妇蛛网膜下腔一次性注入0.1%罗哌卡因2 m L,同时硬膜外腔置管,0.1%罗哌卡因10 m L缓慢注入并留管,根据产妇产程的时间及产妇耐受程度进行硬膜外给药。监测产妇的产程、胎儿的胎心率等相关指标。结果 2组产妇的最终分娩方式无显著差异（P〉0.05）;镇痛后20、30 min,白天组产妇的NRS疼痛评分明显低于夜晚组（P〈0.05）;白天组产妇的产程持续时间显著长于夜晚组（P〈0.05）;白天组新生儿Apagar评分小于7的例数明显高于夜晚组（P〈0.05）。结论生物节律对初产妇分娩方案并没有影响,但对初产妇的镇痛效果和母婴结局都产生一定影响。

Objective To explore the influence of biological rhythm on primiparas delivery plan, analgesic effect and the mother- infant outcomes. Methods A total of 100 women with ma- ternal vaginal delivery plan were divided into day group （ n = 58） and night group （ n = 42） according to the starting time of the periodic pain. Combined block anesthesia was applied in maternal subarachnoid and epidural space of women. After successful puncture of Le-3 or g3.4 clearance, 2 mL 0.1% ropivacaine was iniected into maternal subarachnoid by one time, and meanwhile tube was indwelled in the epidural space with 10 mL 0.1% ropivacaine. Epidural administration was applied according to the time and maternal labor pain tolerance. Fetal heart rate and maternal labor course were monitored. Results There was no significant difference in delivery manner between two groups （P 〉0.05）. After 20 and 30 minutes d analgesia, maternal NRS pain score of the day group was obviously lower than that of the night group （P 〈 0.05）. Maternal labor duration of the day group was significantly longer than that of the night group （P 〈 0.05）. Number of neonates with Apagar score 〈 7 in the day group was significantly larger than that of the night group （P 〈 0.05）. Conclusion The biological rhythm has no impact on primiparas delivery plan, but has impact on primiparas analgesic effect and mother - infant outcomes.