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| 分娩镇痛对子痫前期产妇血流动力学及母婴安全的影响 |
| Effect of labor analgesia on hemodynamics and delivery outcome in preeclampsia patients |
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| DOI：10.12089/jca.2019.08.004 |
| 中文关键词: LiDCO-rapid监测仪 子痫前期 分娩镇痛 血流动力学 |
| 英文关键词: LiDCO-rapid monitor Preeclampsia Labor analgesia Hemodynamics |
| 基金项目:北京市卫生和计划生育委员会科技成果和适宜技术推广项目（2018-TG-21） |
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| 中文摘要: |
目的 应用LiDCO-rapid监测仪管理子痫前期产妇的产程，比较分娩镇痛前后的血流动力学变化及母婴安全。
方法 选择2017年3—11月于本院分娩的初产、单胎子痫前期产妇64例，年龄22～35岁，体重55～85 kg，ASA Ⅱ或Ⅲ级。其中行分娩镇痛的32例产妇纳入分娩镇痛组（LA组），由于产科因素、麻醉禁忌或产妇拒绝椎管内麻醉而未实施分娩镇痛的32例产妇纳入对照组（C组）。LA组在出现子宫规律收缩后进行分娩镇痛，并且持续应用镇痛泵至第一产程结束。产程中应用常规监护仪和LiDCO-rapid监测，记录镇痛前（T0）、镇痛后10 min（T1）、30 min（T2）、60 min（T3）、宫口开全（T4）时的MAP、心输出量（CO）及外周血管阻力（SVR）；记录第一产程、第二产程时间；记录缩宫素、降压药物的使用情况；记录分娩方式、发生子痫和产后出血的情况；记录新生儿出生后1.5和10 min Apgar评分。
结果 与C组比较，LA组第一产程时间、第二产程时间明显延长（P＜0.05），均在正常范围内；T1时MAP明显降低（P＜0.05）；T2—T4时MAP、CO和SVR明显降低（P＜0.05）；缩宫素使用率明显升高（P＜0.05）；降压药物使用率和产钳助产率明显降低（P＜0.05）。LA组新生儿出生后1 min Apgar评分明显低于C组（P＜0.05）。两组均无一例发生子痫及产后出血。
结论 分娩镇痛可有效改善子痫前期产妇产程中的血流动力学状态，降低阴道试产的危险性。LiDCO-rapid帮助产科医师和麻醉科医师了解产妇病理生理变化，并在分娩过程中及时调整治疗。 |
| 英文摘要: |
Objective LiDCO-rapid monitor was used to manage the delivery process in preeclampsia patients, and to compare the hemodynamic changes and delivery outcomes before and after labor analgesia.
Methods Sixty-four cases of primipara and singleton preeclampsia delivered from March to November 2017 were selected, aged 22-35 years, weighing 55-85 kg, ASA physical status Ⅱ or Ⅲ. Thirty-two patients with labor analgesia were included in the labor analgesia group (group LA). Because of obstetric factors, anesthesia contraindications or refusal of intraspinal anesthesia, forty patients who did not perform labor analgesia were enrolled in the control group (group C). In group LA, labor analgesia were performed after regular uterine contraction, and the analgesia pump was used until the end of the first stage of labor. MAP, Cardiac output (CO), systemic vascular resistance (SVR) were recorded before analgesia (T0), 10 min after analgesia (T1), 30 min after analgesia (T2), 60 min after analgesia (T3), and the end of the first stage of labor (T4). The use of oxytocin, hypotensor, eclampsia, postpartum hemorrhage and delivery mode were recorded.
Results Compared with group C, the first and second stages of labor in group LA were significantly prolonged (P < 0.05). MAP decreased significantly at T1-T4 (P < 0.05), while CO and SVR decreased significantly at T2-T4 (P < 0.05). The usage rate of oxytocin increased (P < 0.05) and the usage rate of hypotensor and obstetric forceps decreased significantly (P < 0.05) in group A. There was no case of eclampsia and postpartum hemorrhage in the two groups.
Conclusion Labor analgesia can effectively improve the hemodynamic status of preeclampsia patients during labor and reduce the risk of vaginal delivery. LiDCO-rapid enables obstetricians and anesthesiologists to keep abreast of pathophysiological changes during labor. |
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