硬膜外分娩镇痛对子痫前期产妇子宫动脉及胎儿脐动脉血流指数的影响

Effect of epidural labor analgesia on uterine artery and fetal umbilical artery blood flow indices in women with preeclampsia

目的 观察硬膜外分娩镇痛对子痫前期产妇子宫动脉及胎儿脐动脉血流指数的影响。方法 选择要求行分娩镇痛的单胎足月顺产初产妇共60例,其中合并子痫前期产妇30例,无合并症产妇30例,所有产妇均采用持续硬膜外分娩镇痛。在宫缩间歇期记录所有产妇镇痛前(T0)、镇痛后30 min (T1)以及镇痛后90 min (T2)子宫动脉及胎儿脐动脉阻力指数(RI)、搏动指数(PI)以及收缩期最大峰值流速与舒张末期流速的比值(S/D),并记录以上时刻产妇视觉模拟评分法(VAS)评分、平均动脉压(MAP)、胎心率以及新生儿Apgar评分。结果 在实施分娩镇痛前,子痫前期组产妇子宫动脉血流阻力指标RI、PI及S/D比值均高于正常组产妇(P<0.05),实施分娩镇痛后,两组产妇子宫动脉阻力指标值比较差异无统计学意义(P>0.05);实施分娩镇痛前后两组产妇脐动脉阻力指标比较差异均无统计学意义(P>0.05)。正常组产妇子宫动脉和脐动脉各阻力指标及MAP在实施分娩镇痛前后比较差异无统计学意义(P>0.05);子痫前期组产妇子宫动脉各阻力指标以及MAP在实施分娩镇痛后明显下降(P<0.05),而脐动脉各阻力指标与分娩镇痛前比较差异无统计学意义(P>0.05)。结论 有效的硬膜外分娩镇痛有助于控制子痫前期产妇血压,改善胎儿胎盘循环,改善胎儿氧供,可以降低子痫前期产妇阴道分娩风险。

【Objective】To observe the effects of epidural labor analgesia on uterine artery and fetal umbilical artery blood flow indices in women with preeclampsia.【Methods】A total of 60 primiparous full-term singleton pregnant women requiring labor analgesia were selected,including 30 cases with preeclampsia and 30 cases without complications.All women received continuous epidural labor analgesia.During uterine contraction intervals,uterine artery and fetal umbilical artery resistance indices(RI),pulsatility index(PI),and systolic/diastolic(S/D)ratio were recorded in all women before analgesia(T0),30 minutes after analgesia(T1),and 90 minutes after analgesia(T2).Visual Analog Scale(VAS)scores,mean arterial pressure(MAP),fetal heart rate,and Apgar scores of newborns were also recorded at these time points.【Results】Before the implementation of labor analgesia,the uterine artery blood flow resistance indices RI,PI,and S/D ratio in the preeclampsia group were higher than those in the normal group(P<0.05).After the implementation of labor analgesia,there was no statistically significant difference in uterine artery resistance indices between the two groups(P>0.05).The resistance indices of umbilical artery in both groups showed no statistically significant difference before and after labor analgesia(P>0.05).The resistance indices of uterine artery and umbilical artery, as well as MAP in the normal group, showed no statistically significant difference before and after labor analgesia (P>0.05). The resistance indices of uterine artery and MAP in the preeclampsia group significantly decreased after labor analgesia (P<0.05), while the resistance indices of umbilical artery showed no statistically significant difference compared with those before labor analgesia (P>0.05). 【Conclusion】 Effective epidural labor analgesia helps control blood pressure in women with preeclampsia, improves fetal placental circulation, enhances fetal oxygen supply, and may reduce the risk of vaginal delivery in women with preeclampsia.