不同饮食对低风险产妇硬膜外分娩镇痛及胃排空时间的影响

Effect of different diets on labor outcomes and the gastric emptying time under epidural analgesia in low-risk parturients

目的比较不同饮食对低风险产妇在硬膜外分娩镇痛状态下分娩相关指标及胃排空时间的影响。方法选择单胎头位孕足月低风险初产妇113例,年龄18~35岁,BMI<35 kg/m^(2),ASAⅠ或Ⅱ级,孕期>37周。入产房前4 h以上无进食,接受硬膜外分娩镇痛时宫口扩张≤2 cm。产妇纳入研究后先进行B超下基础胃窦横截面积(CSA)测量,接受硬膜外分娩镇痛后随机分为三组:清水组(W组,n=39)、高能碳水化合物饮料组(C组,n=39)和半固体饮食组(M组,n=35)。W组饮用250 ml清水,C组饮用250 ml术能多维饮料,M组进食面条250 g。记录产妇基础状态、进食后即刻、进食后1、2、3、4、5、6 h的CSA。记录产妇第一和第二产程时间、出血量、剖宫产发生情况。记录新生儿出生后1、5 min Apgar评分、脐动脉血气pH、血糖、乳酸、进入新生儿ICU发生情况。结果三组产妇第一和第二产程时间、失血量、剖宫产率差异均无统计学意义。三组新生儿出生后1、5 min Apgar评分、脐动脉血气pH、血糖、乳酸、进入新生儿ICU发生率差异均无统计学意义。中转剖宫产产妇中有5例转剖宫产时胃未排空,其中W组1例、C和M组各2例,各组转剖宫产产妇均未发生呕吐和反流误吸。W组、C组和M组胃排空时间分别为(85.8±75.3)min、(116.2±86.8)min和(254.7±103.5)min,M组胃排空时间明显长于W组和C组(P<0.05),C组胃排空时间明显长于W组(P<0.05)。结论低风险产妇分娩期间只饮用清水或高能碳水化合物饮料或者进食半固体食物对分娩和新生儿出生后相关结局指标均无明显影响,但分娩镇痛状态下进食半固体食物的产妇胃排空时间最长,分娩过程中仍应限制产妇摄入半固体食物。

Objective To compare labor-related outcomes and the gastric emptying time of low-risk women with different diets during epidural labor analgesia.Methods A total of 113 low-risk nulliparous women at term,aged 18-35 years,BMI<35 kg/m^(2),ASA physical statusⅠorⅡ,gestational age>37 weeks,with a singleton cephalic presenting fetus,fasting for more than four hours before entering the delivery room and receiving epidural labor analgesia with a cervical dilatation of less than or equal to 2 cm.The primary antral cross-sectional area(CSA)was measured by ultrasound after enrollment.Parturients were randomly divided into three groups:the water group(group W,n=39),the carbohydrate drinks group(group C,n=39),and the semisolid food group(group M,n=35).Group W drank 250 ml water,group C drank 250 ml Shuneng carbohydrate beverages,and group M ate 250 g noodles after receiving labor analgesia.CSA was determined at basic status,immediately after ingestion of different food,1 hour,2,3,4,5,and 6 hours after ingestion of different food.The time of the first and second stage of labor,the amount of bleeding and the number of cesarean section were recorded.Apgar score at 1 minute and 5 minutes,umbilical artery blood gas pH,blood glucose,lactic acid and number of entering neonatal ICU were recorded.Results There were no statistical differences in the time of the first and second stage of labor,the amount of bleeding and the mode of delivery among three groups.There were no statistical differences in Apgar score at 1 minute and 5 minutes,umbilical artery blood gas pH,blood glucose,lactic acid and number of entering neonatal ICU among three groups.Five women who were transferred to cesarean delivery had non-emptying stomachs,one was from group W,two were from group C,and two were from group M.All transferred parturients did not experience vomiting or aspiration.The three groups had the gastric emptying time of(85.8±75.3)minutes,(116.2±86.8)minutes,and(254.7±103.5)minutes,respectively.Compared with groups W and C,group M had the longest gastric emptying time(P<0.05).Compared with group W,group C had the longest gastric emptying time(P<0.05).Conclusion Drinking water or carbohydrate beverages or eating semisolid foods during delivery of low-risk parturients had no significant effect on the labor and neonate-related outcomes.Parturients ate semi-solid food under labor analgesia have the longest gastric emptying time,and women should still be restricted from taking semi-solid food during labor.