硬膜外分娩镇痛后孕妇产程入量管理对围产结局影响

Effect of labor process input management on perinatal outcome after epidural labor analgesia

目的研究硬膜外分娩镇痛后孕妇产程入量管理对围产结局的影响。方法选取2019-01-01-2019-09-01中国医科大学附属盛京医院收治的240例足月妊娠妇女作为研究对象,按照组间一般资料具有可比性的原则分为观察组和对照组,各120例。2组均行硬膜外麻醉,观察组给予孕妇口服能量包或静脉滴入能量液;对照组限制孕妇进食,但不禁水。比较2组分娩情况(第一产程时间、第二产程时间、第三产程时间、产后2h出血量、产后血钠水平、阴道分娩转剖宫产、尿酮和呕吐发生情况);比较2组干预前后血液流变学相关指标(血浆黏度、全血还原黏度、红细胞比积水平)及疼痛视觉模拟评分(VAS);比较新生儿脐动脉血血气分析结果[氧分压(PO_(2))、二氧化碳分压(PCO_(2))、碳酸氢根(HCO_(3))、血糖(BG)水平和氢离子浓度指数(pH)]及1min阿氏(Apgar)评分;比较2组不良围产结局发生情况。结果观察组第二产程时间、第三产程时间、产后2h出血量分别为(0.81±0.16)h、(0.22±0.04)h和(151.67±18.46)mL,低于对照组的(0.86±0.17)h、(0.24±0.08)h和(162.38±18.65)mL,差异有统计学意义,t值分别为2.346、2.450和4.471,P值分别为0.020、0.015和<0.001。干预后,观察组血浆黏度、全血还原黏度分别为(1.18±0.19)和(5.86±0.97)mPa/s,低于对照组的(1.24±0.20)和(6.14±0.84)mPa/s,差异有统计学意义,t值分别为2.383和2.390,P值均为0.018。观察组新生儿脐动脉血中pH、PCO_(2)、HCO_(3)及新生儿1min Apgar评分分别为(7.30±0.15)、(50.48±4.51)mm Hg、(21.46±2.34)mmol/L及(9.58±0.21)分,高于对照组的(7.24±0.14)、(48.86±4.54)mm Hg、(20.51±2.15)mmol/L及(9.52±0.18)分,差异有统计学意义,t值分别为3.203、2.773、3.275和2.376,P值分别为0.002、0.006、0.001和0.018。观察组不良围产结局总发生率为7.50%,低于对照组的16.67%,差异有统计学意义,χ^(2)=4.746,P=0.029。结论硬膜外分娩镇痛后行产程入量管理可改善围产结局,表现为缩短第二及第三产程时间、减少产后出血、降低不良围产结局发生风险。

Objective To study the effect of labor process input management on perinatal outcome after epidural labor analgesia.Methods 240 cases of full-term pregnant women in Shengjing Hospital Affiliated to China Medical University from January 1,2019 to September 1,2019 were selected as the research objects.According to the method of random number table,they were divided into experimental group and control group,120 cases in each group.Both groups were given epidural anesthesia.The experimental group was given energy packs or intravenous drip of energy solution to pregnant women.The control group restricted pregnant women’s eating,but could not help drinking water.To compare the delivery conditions of two groups of pregnant women(the first stage of labor,the second stage of labor,the third stage of labor,the amount of 2-hours postpartum hemorrhage,the postpartum blood sodium level and the occurrence of vaginal delivery,cesarean section,Urone and vomiting).The hemorheological indexes(plasma viscosity,whole blood reduced viscosity,hematocrit level)and pain visual analogue(VAS)scores before and after intervention were compared between the two groups.The results of blood gas analysis(PO_(2),PCO_(2),HCO_(3),BG and pH)and Apgar scores were compared.The adverse perinatal outcomes of the two groups were compared.Results The duration of the second stage of labor,the third stage of labor,and the amount of postpartum blood loss 2 hin the observation group were(0.81±0.16)h,(0.22±0.04)h,(151.67±18.46)ml,respectively,significantly lower than those in the control group(0.86±0.17)h,(0.24±0.08)h,(162.38±18.65)ml,respectively.The difference was statistically significant(t value was 2.346,2.450,4.471,Pvalue was 0.020,0.015,<0.001).After intervention,plasma viscosity and whole blood reduced viscosity of the observation group were(1.18±0.19)mPa/s and(5.86±0.97)mPa/s,respectively,significantly lower than those of the control group(1.24±0.20)mPa/s and(6.14±0.84)mPa/s,with statistical significance(t value was 2.383,2.390,all P=0.018).The pH,PCO_(2),HCO_(3)in umbilical blood of group A and neonates were observed for 1 min Apgar scores of(7.30±0.15),(50.48±4.51)mm Hg,(21.46±2.34)mmol/L and(9.58±0.21)points were significantly higher than those of the control group(7.24±0.14),(48.86±4.54)mm Hg,(20.51±2.15)mmol/L and(9.52±0.18),the difference was statistically significant(t value was 3.203,2.773,3.275,2.376,Pvalue was 0.002,0.006,0.001,0.018).The total incidence of adverse perinatal outcome in the experimental group was 7.50%,which was significantly lower than that in the control group(16.67%),χ^(2)=4.746,P=0.029.Conclusion After epidural labor analgesia,the amount of labor management can improve the perinatal outcomes,such as shortening the time of the second and third stages of labor,reducing postpartum hemorrhage,and reducing the risk of adverse perinatal outcomes.