COOK球囊人工破膜产前干预对新生儿结局影响临床分析

Clinical analysis of the effect of prenatal intervention by COOK balloon combined with artificial rupture on neonatal outcomes

目的探讨COOK宫颈球囊联合人工破膜产前干预促宫颈成熟对于新生儿结局的影响。方法收集2014年11月至2016年10月在解放军第一八一医院产科住院待产有引产指征的111例产妇的临床资料,采用随机数字表法分为两组:58例用COOK宫颈球囊后行人工破膜的产妇纳入试验组;53例静滴催产素+人工破膜引产的纳入对照组。对两组孕妇情况以及新生儿结局进行对比分析。结果试验组新生儿5min Apgar评分与对照组比较无统计学差异(t=3.08,P>0.05),新生儿窒息复苏病率、感染病率差异无统计学意义(χ2值分别为2.96,2.14,均P>0.05)。试验组新生儿高胆红素血症病率明显低于对照组,差异有统计学意义(χ2=6.43,P<0.05)。试验组年龄、孕周、产次与对照组比较无统计学差异(t值分别为2.33、3.11、2.58,均P>0.05)。试验组羊水少、胆汁淤积、妊娠期糖尿病、过期妊娠与对照组无统计学差异(χ2值分别为5.48、6.02、5.33、5.89,均P>0.05)。试验组宫颈成熟率(χ2=8.64)、点滴催产素时间、总产程(t值分别为10.54、7.62)与对照组比较差异较显著(均P<0.05)。结论 COOK宫颈球囊促进宫颈成熟引产的方法对新生儿结局的影响与催产素点滴引产相比无统计学差异,使用安全,值得推广普及,但在新生儿高胆红素血症的发生率较催产素点滴引产者低。

Objective To explore the effect of prenatal intervention by COOK cervical balloon combined with artificial rupture for promoting cervical ripening on neonatal outcomes.Methods The clinical data of 111 puerperae with indication for induced labor who were admitted to the department of obstetrics in the 181 st Hospital of Chinese People＇s Liberation Army during November 2014 to October 2016 was collected,and the puerperae were divided into 2 groups according to random data table.Total 58 cases receiving artificial rupture after COOK cervical balloon were brought into experimental group,while 53 cases receiving oxytocin through intravenous drip and artificial rupture were brought into control group.The conditions of pregnant women and neonatal outcomes were compared and analyzed between two groups.Results There was no significant difference in neonatal Apgar 5 minutes score between the experimental group and the control group（t=3.08,P 0.05）.The differences in occurrence rates of neonatal asphyxia resuscitation and infection showed no statistical significance between two groups（χ2 value was 2.96 and 2.14,respectively,both P 0.05）.The incidence of neonatal hyperbilirubinemia among neonates in the experimental group was significantly lower than that in the control group（χ2=6.43,P0.05）.There were no statistical differences in age,gestational weeks and parity between two groups（t value was 2.33,3.11 and 2.58,respectively,all P 0.05）.And the differences in oligohydramnios,cholestasis,gestational diabetes mellitus and prolonged pregnancy between two groups were not significant（χ2 value was 5.48,6.02,5.33 and 5.89,respectively,all P0.05）.However,the cervical ripening rate（χ2=8.64）,time of receiving oxytocin and total duration of labor（t value was 10.54 and 7.62,respectively）in the experimental group were significantly different from those in the control group（all P0.05）.Conclusion Compared with induced labor by oxytocin through intravenous drip,prenatal intervention by COOK cervical balloon combined with artificial rupture for promoting cervical ripening has no statistically difference in effect on neonatal outcomes.It is safe and deserves to be popularized with lower occurrence rate of neonatal hyperbilirubinemia than conventional induced labor with oxytocin through intravenous drip.