分娩镇痛期间镇静程度与胎心变化规律的临床观测

Clinical observation on the trends of maternal sedation degree and fetal heart rate under labor analgesia

目的评价观测分娩镇痛期间产妇镇静程度与胎心的变化规律。方法收集自然分娩初产妇100例,年龄22~30岁,ASA分级Ⅱ级,孕38~40周,采用随机数字表法分为常规分娩组和分娩镇痛组,每组50例。常规分娩组按正常阴道分娩步骤实施,不采取任何方式镇痛;分娩镇痛组待宫口开至2~3 cm时采用腰L3-4硬膜外镇痛,随后接电子镇痛泵。比较两组产妇宫口开至3 cm前(T0)、宫口开至3 cm后0 min(T1)、3 min(T2)、5 min(T3)、10 min(T4)、20 min(T5)、30 min(T6)、60 min(T7)时的胎心率及胎心变异数据、产妇心率、平均动脉压、宫缩压力、宫缩时长、麻醉趋势指数(NI)以及胎儿出生后脐动脉pH值和产妇主诉嗜睡时间。结果与常规分娩组比较,分娩镇痛组的胎心率T4和T6时明显降低、T5时明显升高,胎心变异T4时明显降低(P<0.05);产妇心率T6时明显降低,平均动脉压T6、T7时明显降低(P<0.05);宫缩压力T3时明显降低,宫缩时长T3、T5、T6时延长(P<0.05);NI在T5时明显降低(P<0.05);产妇主诉嗜睡时间明显增长;T3时胎心变异与产妇镇静程度呈负相关,T6时胎心率与产妇镇静程度呈负相关。结论分娩镇痛期间胎心变异改变,可能与分娩镇痛期间的镇静程度和宫缩模式改变相关,与分娩镇痛期间循环改变无关,但上述变化并未对分娩结局产生不良影响。

Objective To observe the trends of maternal sedation degree and fetal heart rate under labor analgesia.Methods One hundred primipara with natural delivery,aged 22 to 30 years,ASAⅡgrade,pregnancy between 38 and 40 weeks,were collected and divided into routine delivery group and analgesia delivery group by random number table(n=50).The puerperae experienced normal vaginal delivery in routine delivery group without any analgesia;while the puerperae received epidural analgesia in analgesia delivery group.Lumbar L3-4 was selected for epidural analgesia when the cervical opening of 2 to 3 cm.Continuous analgesia was applied with electronic analgesia pump.Fetal heart rate and variability,heart rate and mean artery pressure of puerperae,the uterine contractility,duration of uterine contraction,Narcotrend Index(NI)of frontal region were compared between the two groups before 3 cm of uterine opening(T0)and after 3 cm of uterine opening at 0 min(T1),3 min(T2),5 min(T3),10 min(T4),20 min(T5),30 min(T6),and 60 min(T7).Umbilical artery PH value and puerpera somnolence duration were also compared between the two groups after delivery.Results Compared with the routine delivery group,fetal heart rate of the analgesia delivery group significantly decreased at T4 and T6,and significantly increased at T5;with fetal heart rate variability significantly decreased at T4(P<0.05).The puerpera heart rate significantly decreased at T6,mean artery pressure also significantly decreased at T6 and T7 in analgesia delivery group(P<0.05).The uterine contractility significantly decreased at T3,the duration of uterine contraction were extended at T3,T5 and T6 in analgesia delivery group(P<0.05).NI were significantly reduced at T5(P<0.05).Puerpera somnolence duration significantly increased,as per the analysis fetal heart variability was negatively correlated with puerpera sedative degree at T3,and so as the same for fetal heart rate and puerpera sedative degree at T6.Conclusion Fetal heart rate variability after analgesia delivery may be connected with puerpera sedative degree and uterine contraction pattern change,rather than the circulatory change after analgesia delivery,but turns out the variability mentioned above have no impact on the delivery results.