改良侧卧位+脉冲波分娩镇痛在妊娠期糖尿病孕妇分娩期中的应用

Effects of modified body position management combined with pulse wave labor analgesia on the delivery outcome in pregnant women with gestational diabetes mellitus

目的探讨改良腰麻侧卧位为主的体位管理联合脉冲波分娩镇痛对妊娠期糖尿病孕妇分娩结局的影响。方法妊娠期糖尿病孕妇134例随机分为传统组和试验组,每组67例。传统组采用拉玛泽呼吸减痛,孕妇以自觉舒适的自主体位待产,助产士对体位不进行指导。试验组则采用脉冲波分娩镇痛仪进行减痛,在待产过程中采用以改良腰麻侧卧位为主的体位待产。观察产程时间、母儿血糖水平、镇痛满意度及分娩结局。结果试验组第一、二产程时间较传统组明显缩短,阴道分娩率、pH值、剩余碱、新生儿血糖、满意度高于传统组,剖宫产率、产后出血率、巨大儿发生率、高胆红素血症发生率、孕妇血糖波动、疼痛评分均低于传统组,差异均有统计学意义(P<0.05)。结论在妊娠期糖尿病孕妇产程中应用以改良腰麻侧卧位为主的体位管理联合脉冲波分娩镇痛可以缓解疼痛,平稳血糖,减少分娩并发症,促进自然分娩。

Objective To investigate the effects of modified body position management(predominantly lateral decubitus position during spinal anesthesia)combined with pulse wave labor analgesia on the delivery outcome of pregnant women with gestational diabetes mellitus(GDM).Methods A total of 134 pregnant women with GDM were randomly divided into traditional treatment group and experimental group,with 67 cases in each group.In the traditional treatment group,Lamaze childbirth breathing was used to relieve pain.The pregnant women waited for delivery in a comfortable position,and the midwife did not guide the position.In the experimental group,the pulse wave delivery analgesic instrument was used to reduce pain,and modified body position(predominantly lateral decubitus position during spinal anesthesia)was adopted during labor.The duration of labor,the blood glucose level of mother and child,satisfaction with analgesia and the outcome of delivery were observed.Results The first and second stages of labor in experimental group were significantly shorter than those in traditional treatment group.The vaginal delivery rate,pH value,residual alkali,neonatal blood sugar,and satisfaction degree in experimental group were significantly higher than those in traditional treatment group,however,the cesarean section rate,postpartum hemorrhage,incidence rates of macrosomia and bilirubinemia,blood glucose fluctuations and pain scores in experimental group were significantly lower than those in traditional treatment group(P<0.05).Conclusion For pregnant women with GDM,the application of position management,predominantly lateral decubitus position during spinal anesthesia,combined with pulse wave labor analgesia can relieve pain,stabilize blood sugar,reduce labor complications,and promote natural delivery.