硬膜外分娩镇痛对胎儿脐动脉和大脑中动脉血流的影响

Effects of labor analgesia on maternal and neonatal outcomes monitored using Doppler ultrasound

目的运用多普勒超声观察硬膜外分娩镇痛对胎儿脐动脉和大脑中动脉血流的影响。方法选择要求硬膜外分娩镇痛的产妇59例（R组）,同时选取拒绝分娩镇痛产妇25例（N组）。记录产妇产程时间、出血量、分娩方式、新生儿情况。当宫口开至2 cm时,R组记录镇痛前（T0）、镇痛后15 min（T1）、镇痛后30 min（T2）和镇痛后60 min（T3）胎儿大脑中动脉、脐动脉阻力指数（RI）、搏动指数（PI）和最大峰值血流速度/舒张末期血流速度（S/D）,N组在相同时间间隔记录上述参数。结果两组产妇产程时间、出血量及分娩方式差异无统计学意义。T0~T2时,R组胎儿大脑中动脉、脐动脉PI和S/D有下降趋势,大脑中动脉RI有增加趋势,但组内差异无统计学意义。N组在各时点无明显改变,组间差异无统计学意义。结论硬膜外分娩镇痛对母婴无明显影响,不良反应少,有很好的临床应用价值。

Objective To observe the effects of labor analgesia on the maternal and neonatal outcomes using Doppler ultrasound. Methods Fifty-nine primipara who required labor analgesia were included into group R,while 25 primipara who rejected labor analgesia were included into group N. The duration of labor process,bleeding volume,method of labor and the neonatal outcomes were recorded and compared between the two groups. Moreover,pulsatility index（ PI）,resistance index（ RI）,and systolic / diastolic（ S/D） were also recorded at the time before analgesia（ T0）,15 min after analgesia（ T1）,30 min after analgesia（ T2） and 60 min after analgesia（ T3） between the two groups. At the same time,RI,PI and S/D were also recorded in the group N. Results There were no significant differences in the duration of labor process,bleeding volume,method of labor and neonatal outcomes. And patients in the group R presented a decreasing trend in PI and S / D as well as an upward trend in RI after labor analgesia,but the differences were not significant. Furthermore,the changes in each index of the patients in group N were not significant,either. Conclusion Epidural labor analgesia does not affect maternal and neonatal outcomes,which can be safely used in clinic with little side effects.