人工破膜联合催产素静脉滴注与米索前列醇在低宫颈成熟度产妇催产中使用效果对比

Comparison of the effect of artificial rupture of membranes combined with oxytocin intravenous drip and misoprostol in inducing labor in women with low cervical maturity

目的比较人工破膜联合催产素静脉滴注与米索前列醇在低宫颈成熟度产妇催产中的使用效果。方法前瞻性选取2019年1月至2022年10月在合肥市第二人民医院进行引产的足月妊娠产妇80例,采用信封法随机分为两组。对照组36例采取米索前列醇,观察组44例采取人工破膜联合催产素静脉滴注。比较两组分娩方式、引产至临产时间、产程、产后24 h出血量、血红蛋白下降量、胎儿血气指标[pH值、动脉二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))、碱剩余]的差异,统计引产成功率及新生儿、产妇并发症情况。结果观察组顺产率为84.09%,高于对照组(61.11%),差异有统计学意义(P<0.05)。观察组引产至临产时间及第一产程、第二产程、总产程分别为(20.10±2.89)、(5.57±1.06)、(1.20±0.61)、(7.35±2.04)h,均短于对照组[(22.25±3.23)、(6.98±1.74)、(1.54±0.86)、(9.87±2.26)h],差异均有统计学意义(P<0.05)。观察组的新生儿窒息率、产后出血率分别为4.55%、0,均低于对照组(19.44%、11.11%),差异均有统计学意义(P<0.05);两组剖宫产率、阴道助产率、引产成功率、胎儿窘迫率、羊水污染率、宫颈裂伤率及产后24 h出血量、血红蛋白下降量比较,差异均无统计学意义(P>0.05)。观察组胎儿pH值、PaCO_(2)、剩余碱分别为7.24±0.08、(49.36±4.17)kPa、(-3.12±0.61)mEq/L,均低于对照组[7.32±0.10、(54.52±5.66)kPa、(-3.45±0.84)mEq/L],PaO_(2)为(20.87±3.67)kPa,高于对照组[(19.16±3.74)kPa],差异均有统计学意义(P<0.05)。结论人工破膜联合催产素静脉滴注较米索前列醇在促进产妇宫颈成熟方面效果更好,不仅可缩短产程,提高顺产率,还可降低新生儿窒息率和产后出血率,且对胎儿血气影响较小。

Objective To compare the effect of artificial rupture of membranes combined with intravenous drip of oxytocin and misoprostol in inducing labor in women with low cervical maturity.Methods Eighty full-term pregnant women who underwent labor induction in the Second People's Hospital of Hefei from January 2019 to October 2022 were prospectively selected and randomly divided into two groups by envelope method.Thirty-six cases in control group received misoprostol,44 cases in observation group received artificial membrane rupture combined with oxytocin drops.The differences of delivery mode,time from labor induction to labor,labor process,postpartum blood loss 24 h,hemoglobin decline and fetal blood gas index[pH value,partial pressure of carbon dioxide(PaCO_(2)),oxygen partial pressure(PaO_(2)),base excess]were compared between the two groups.The success rate of labor induction and neonatal and maternal complications were analyzed.Results The vaginal delivery rate of the observation group was 84.09%,which was higher than that of the control group(61.11%),the difference was statistically significant(P<0.05).The time from labor induction to labor,the first stage,the second stage and the total stage of the observation group were(20.10±2.89),(5.57±1.06),(1.20±0.61),(7.35±2.04)h,respectively,which were shorter than those of the control group[(22.25±3.23),(6.98±1.74),(1.54±0.86),(9.87±2.26)h],the differences were statistically significant(P<0.05).The neonatal asphyxia rate and postpartum hemorrhage rate of the observation group were 4.55%and 0,respectively,which were lower than those of the control group(19.44%and 11.11%),the differences were statistically significant(P<0.05).There were no statistical differences on the rate of cesarean section,vaginal midwifing rate,labor induction success rate,fetal distress rate,amniotic fluid contamination rate,cervical laceration rate,postpartum 24 h blood loss and Hb decline in the two groups(P>0.05).The fetal pH value,PaCO_(2) and the base excess in the observation group were 7.24±0.08,(49.36±4.17)kPa,(-3.12±0.61)mEq/L,which were lower than those in the control group[7.32±0.10,(54.52±5.66)kPa,(-3.45±0.84)mEq/L],PaO_(2) was(20.87±3.67)kPa,which was higher than that of the control group[(19.16±3.74)kPa],the differences were statistically significant(P<0.05).Conclusion Artificial membrane breaking combined with oxytocin intravenous drip is better than misoprostol in promoting the cervical maturity of parturients.It can not only shorten the labor process,improve the rate of spontaneous labor,but also reduce the rate of neonatal asphyxia and postpartum hemorrhage,and has little impact on fetal blood gas.