硬膜外麻醉镇痛对COOK双球囊引产效果和母婴结局的影响
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摘要
目的探讨足月妊娠初产妇硬膜外麻醉镇痛对COOK双球囊引产效果和母婴结局的影响。方法回顾性分析我院2017年12月至2018年12月行COOK双球囊引产的91例足月妊娠初产妇的临床资料,按照是否接受硬膜外麻醉镇痛分为无痛分娩组和常规分娩组。观察比较2组患者的分娩方式以及阴道分娩患者的产程、母婴并发症和抗生素使用情况。结果无痛分娩组的阴道分娩率为91. 67%,常规分娩组为50. 91%。阴道分娩患者中无痛分娩者的第一产程、第二产程均比常规分娩者长;球囊后24 h内阴道分娩率、破水后12 h内阴道分娩率均低于常规分娩患者;产前发热率、抗生素使用率和产后出血量均明显高于常规分娩患者,差异均有统计学意义(P <0. 05)。2组患者的新生儿窒息率比较差异无统计学意义(P> 0. 05)。结论无痛分娩可提高COOK球囊引产成功率,但延长了产程,会对分娩造成不良影响,应予重视和预防。
Objective To explore the influence of epidural analgesia( EA) on the effect of term labor induction of primiparous women by COOK double ballon,and evaluate the maternal and neonatal outcomes. Methods The data of 91 primiparous women who received COOK double ballon for induction of term labor were retrospectively analyzed. The cases received EA were named as group EA + COOK and others were named as group COOK. The mode of delivery was observed and compared between the two groups. The duration of labor,maternal complications,infant complications and medication of antibiotic of the patients delivered vaginally were observed and compared between the two groups. Results The vaginal delivery rate was 91. 67% in the group EA + COOK and 50. 91% in the group COOK. The first stage of labor and the second stage of labor in group EA + COOK were longer than those in group COOK,the vaginal delivery rate within 24 hours after balloon delivery and the vaginal delivery rate within 12 hours after rupture of membrance in group EA + COOK were lower than those in group COOK,and the rate of prenatal fever,the usage rate of antibiotics and the amount of postpartum hemorrhage in group EA + COOK were significantly higher than those in group COOK,the differences were significant( P < 0. 05). There was no statistical difference in the incidence of neonatal asphyxia between the two groups. Conclusion EA can promote the effectiveness of COOK double ballon for induction of term labor of primiparous women,whereas,more attention and interventions were needed because EA will prolong the labor stage and result in some adverse events.
Objective To explore the influence of epidural analgesia( EA) on the effect of term labor induction of primiparous women by COOK double ballon,and evaluate the maternal and neonatal outcomes. Methods The data of 91 primiparous women who received COOK double ballon for induction of term labor were retrospectively analyzed. The cases received EA were named as group EA + COOK and others were named as group COOK. The mode of delivery was observed and compared between the two groups. The duration of labor,maternal complications,infant complications and medication of antibiotic of the patients delivered vaginally were observed and compared between the two groups. Results The vaginal delivery rate was 91. 67% in the group EA + COOK and 50. 91% in the group COOK. The first stage of labor and the second stage of labor in group EA + COOK were longer than those in group COOK,the vaginal delivery rate within 24 hours after balloon delivery and the vaginal delivery rate within 12 hours after rupture of membrance in group EA + COOK were lower than those in group COOK,and the rate of prenatal fever,the usage rate of antibiotics and the amount of postpartum hemorrhage in group EA + COOK were significantly higher than those in group COOK,the differences were significant( P < 0. 05). There was no statistical difference in the incidence of neonatal asphyxia between the two groups. Conclusion EA can promote the effectiveness of COOK double ballon for induction of term labor of primiparous women,whereas,more attention and interventions were needed because EA will prolong the labor stage and result in some adverse events.
引文
[1]陈平. COOK球囊在低宫颈Bishop评分足月妊娠引产中的应用[J].中南医学科学杂志,2017,45(6):584-587. doi:10. 15972/j. cnki. 43-1509/r. 2017. 06. 012.
[2]Wu X,Wang C,Li Y,et al. Cervical dilation balloon combined with intravenous drip of oxytocin for induction of term labor:a multicenter clinical trial[J]. Arch Gynecol Obstet,2018,297(1):77-83. doi:10. 1007/s00404-017-4564-9.
[3]中华医学会妇产科学分会产科学组.妊娠晚期促子宫颈成熟与引产指南[J].中华妇产科杂志,2014,49(12):881-885. doi:10.16281/j. cnki. jocml. 2017. 89. 028.
[4]全紫薇,金华.分娩镇痛在产程中的管理与应用研究[J].医学研究杂志,2018,47(1):179-181. doi:10. 11969/j. issn. 1673-548X.2018. 01. 045.
[5]Kranke P,Annecke T,Bremerich DH,et al. Anesthesia in obstetrics:Tried and trusted methods,current standards and new challenges[J]. Anaesthesist,2016,65(1):3-21. doi:10. 1007/s00101-015-0129-0.
[6]鲁恒,黄绍强,胡建英,等.低浓度与超低浓度罗哌卡因间断硬膜外给药用于分娩镇痛的效果及对产科结局的影响[J].复旦学报(医学版),2017,44(4):498-502. doi:10. 3969/j. issn. 1672-8467. 2017. 04. 018.
[7]黄保华,远光,吴安石.两种不同浓度舒芬太尼配伍罗哌卡因用于硬膜外分娩镇痛的效果比较[J].北京医学,2016,38(6):551-554. doi:10. 15932/j. 0253-9713. 2016. 6. 017.
[8]黎文敏.浅析足月妊娠产妇产前发热与麻醉方法之间的关系[J].当代医药论丛,2014,12(11):272-273. doi:10. 3969/j. issn. 2095-7629. 2014. 11. 253.
[9]Curtin WM,Katzman PJ,Florescue H,et al. Intrapartum fever,epidural analgesia and histologic chorioamnionitis[J]. J Perinatol,2015,35(6):396-400. doi:10. 1038/jp. 2014. 235.
[10] Lavesson T,Kallen K,Olofsson P. Fetal and maternal temperatures during labor and delivery:a prospective descriptive study[J]. J Matern Fetal neonatal Med,2018,31(12):1533-1541. doi:10. 1080/14767058. 2017. 1319928.
[11]卢园园,卫亮,夏瑞强,等.不同浓度罗哌卡因复合舒芬太尼硬膜外分娩镇痛对发热的影响[J].中华麻醉学杂志,2018,38(9):1042-1044. doi:10. 3760/cma. j. issn. 0254-1416. 2018. 09. 005.
[12]Srebnik N,Barkan O,Rottenstreich M,et al. The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor[J]. J Matern Fetal Neonatal Med,2019,4:1-8. doi:10. 1080/14767058. 2018. 1554045.
[13]李鹏飞.探讨盐酸罗哌卡因联合舒芬太尼硬膜外麻醉用于无痛分娩的麻醉效果[J].世界最新医学信息文摘,2017,17(28):38-39. doi:10. 3969/j. issn. 1671-3141. 2017. 28. 017.
[14]纪淑敏.不同浓度罗哌卡因配伍舒芬太尼用于产妇分娩镇痛的临床效果观察[J].中国计划生育学杂志,2017,25(5):323-327.doi:10. 3969/j. issn. 1004-8189. 2017. 05. 007.
[15]Wang Q,Zheng SX,Ni YF,et al. The effect of labor epidural analgesia on maternal-fetal outcomes:a retrospective cohort study[J]. Arch Gynecol Obstet,2018,298(1):89-96. doi:10. 1007/s00404-018-4777-6.
[16]刘冬红,霍红艳.腰硬联合麻醉复合术后硬膜外镇痛对足月妊娠初产妇行无痛分娩产程时间及术后血清PRL、t-PA水平变化的影响[J].中国妇幼保健,2018,33(24):6037-6040. doi:10. 7620/zgfybj. j. issn. 1001-4411. 2018. 24. 125.
[17]邢顺莲,吕伟冬,王艳芳,等.产房开放联合无痛分娩在产科的应用及对分娩过程的影响[J].中国妇产科临床杂志,2019,20(1):75-76. doi:10. 13390/j. issn. 1672-1861. 2019. 01. 029.
[18]姜群,孙洪涛.无痛分娩460例临床分析[J].世界最新医学信息文摘,2017,17(93):75-84. doi:10. 19613/j. cnki. 1671-3141.2017. 93. 054.
[19]王志勇,曹树军.硬膜外麻醉联合全程小剂量缩宫素在镇痛分娩中的应用效果观察[J].中国妇幼保健,2018,33(12):2812-2814. doi:10. 7620/zgfybj. j. issn. 1001-4411. 2018. 12. 59.
[20]俎晓霞,刘晓敏,申慧军,等.自控硬膜外镇痛分娩175例临床分析[J].长治医学院学报,2017,31(3):204-206. doi:10. 3969/j.issn. 1006-0588. 2017. 03. 013.
[21]王孝贤,李颖,张莉,等.探讨无痛分娩中第二产程的体位管理对第二产程及分娩结局的影响[J].中国妇幼保健,2018,33(14):3169-3171. doi:10. 7620/zgfybj. j. issn. 1001-4411.2018. 14. 15.
[2]Wu X,Wang C,Li Y,et al. Cervical dilation balloon combined with intravenous drip of oxytocin for induction of term labor:a multicenter clinical trial[J]. Arch Gynecol Obstet,2018,297(1):77-83. doi:10. 1007/s00404-017-4564-9.
[3]中华医学会妇产科学分会产科学组.妊娠晚期促子宫颈成熟与引产指南[J].中华妇产科杂志,2014,49(12):881-885. doi:10.16281/j. cnki. jocml. 2017. 89. 028.
[4]全紫薇,金华.分娩镇痛在产程中的管理与应用研究[J].医学研究杂志,2018,47(1):179-181. doi:10. 11969/j. issn. 1673-548X.2018. 01. 045.
[5]Kranke P,Annecke T,Bremerich DH,et al. Anesthesia in obstetrics:Tried and trusted methods,current standards and new challenges[J]. Anaesthesist,2016,65(1):3-21. doi:10. 1007/s00101-015-0129-0.
[6]鲁恒,黄绍强,胡建英,等.低浓度与超低浓度罗哌卡因间断硬膜外给药用于分娩镇痛的效果及对产科结局的影响[J].复旦学报(医学版),2017,44(4):498-502. doi:10. 3969/j. issn. 1672-8467. 2017. 04. 018.
[7]黄保华,远光,吴安石.两种不同浓度舒芬太尼配伍罗哌卡因用于硬膜外分娩镇痛的效果比较[J].北京医学,2016,38(6):551-554. doi:10. 15932/j. 0253-9713. 2016. 6. 017.
[8]黎文敏.浅析足月妊娠产妇产前发热与麻醉方法之间的关系[J].当代医药论丛,2014,12(11):272-273. doi:10. 3969/j. issn. 2095-7629. 2014. 11. 253.
[9]Curtin WM,Katzman PJ,Florescue H,et al. Intrapartum fever,epidural analgesia and histologic chorioamnionitis[J]. J Perinatol,2015,35(6):396-400. doi:10. 1038/jp. 2014. 235.
[10] Lavesson T,Kallen K,Olofsson P. Fetal and maternal temperatures during labor and delivery:a prospective descriptive study[J]. J Matern Fetal neonatal Med,2018,31(12):1533-1541. doi:10. 1080/14767058. 2017. 1319928.
[11]卢园园,卫亮,夏瑞强,等.不同浓度罗哌卡因复合舒芬太尼硬膜外分娩镇痛对发热的影响[J].中华麻醉学杂志,2018,38(9):1042-1044. doi:10. 3760/cma. j. issn. 0254-1416. 2018. 09. 005.
[12]Srebnik N,Barkan O,Rottenstreich M,et al. The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor[J]. J Matern Fetal Neonatal Med,2019,4:1-8. doi:10. 1080/14767058. 2018. 1554045.
[13]李鹏飞.探讨盐酸罗哌卡因联合舒芬太尼硬膜外麻醉用于无痛分娩的麻醉效果[J].世界最新医学信息文摘,2017,17(28):38-39. doi:10. 3969/j. issn. 1671-3141. 2017. 28. 017.
[14]纪淑敏.不同浓度罗哌卡因配伍舒芬太尼用于产妇分娩镇痛的临床效果观察[J].中国计划生育学杂志,2017,25(5):323-327.doi:10. 3969/j. issn. 1004-8189. 2017. 05. 007.
[15]Wang Q,Zheng SX,Ni YF,et al. The effect of labor epidural analgesia on maternal-fetal outcomes:a retrospective cohort study[J]. Arch Gynecol Obstet,2018,298(1):89-96. doi:10. 1007/s00404-018-4777-6.
[16]刘冬红,霍红艳.腰硬联合麻醉复合术后硬膜外镇痛对足月妊娠初产妇行无痛分娩产程时间及术后血清PRL、t-PA水平变化的影响[J].中国妇幼保健,2018,33(24):6037-6040. doi:10. 7620/zgfybj. j. issn. 1001-4411. 2018. 24. 125.
[17]邢顺莲,吕伟冬,王艳芳,等.产房开放联合无痛分娩在产科的应用及对分娩过程的影响[J].中国妇产科临床杂志,2019,20(1):75-76. doi:10. 13390/j. issn. 1672-1861. 2019. 01. 029.
[18]姜群,孙洪涛.无痛分娩460例临床分析[J].世界最新医学信息文摘,2017,17(93):75-84. doi:10. 19613/j. cnki. 1671-3141.2017. 93. 054.
[19]王志勇,曹树军.硬膜外麻醉联合全程小剂量缩宫素在镇痛分娩中的应用效果观察[J].中国妇幼保健,2018,33(12):2812-2814. doi:10. 7620/zgfybj. j. issn. 1001-4411. 2018. 12. 59.
[20]俎晓霞,刘晓敏,申慧军,等.自控硬膜外镇痛分娩175例临床分析[J].长治医学院学报,2017,31(3):204-206. doi:10. 3969/j.issn. 1006-0588. 2017. 03. 013.
[21]王孝贤,李颖,张莉,等.探讨无痛分娩中第二产程的体位管理对第二产程及分娩结局的影响[J].中国妇幼保健,2018,33(14):3169-3171. doi:10. 7620/zgfybj. j. issn. 1001-4411.2018. 14. 15.