3种不同分娩方式对母婴围产期并发症的影响

 目的 比较3种不同分娩方式对产妇及新生儿围产期并发症的影响，探讨理想的分娩方式。方法 选择ASAⅠ~Ⅱ级、足月妊娠、单胎头位产妇60例，随机分为3组，每组各20例。Ⅰ组(剖宫产组）经L2-3间隙穿刺行硬膜外麻醉，硬膜外腔注入0.5%罗哌卡因，调整麻醉平面为T6~S4，术中不用辅助药，术后行硬膜外镇痛。Ⅱ组（分娩镇痛组）于产妇宫口开至3 cm左右进入活跃期时，行L2-3硬膜外常规穿刺并向头端置管，注入0.125%罗哌卡因+芬太尼2 μg/mL，首剂8~10 mL，控制平面在T10以下，待获得满意镇痛效果后接PCA泵，维持量6~8 mL/h，bolus剂量5 mL，锁定时间20 min，至宫口开全时停药。Ⅲ组（自然分娩组）按正常分娩常规程序处理。3组病人术中均予吸氧。记录新生儿出生后1 min、5 min的Apgar评分，以及15 min、24 h的神经行为与适应能力评分（neurological and adaptive capacity score，NACS）。胎儿娩出时抽取脐静脉血2 mL行血气分析及乳酸测定，监测产妇分娩过程中的HR、RR、BP，记录产妇术后并发症和恢复情况。结果 新生儿出生后1、5 min的Apgar评分，15 min、24 h的NACS评分3组比较差异无统计学意义。3组脐静脉乳酸含量比较，Ⅱ组与Ⅲ组高于Ⅰ组，Ⅲ组高于Ⅱ组。BE Ⅲ组高于Ⅰ组。3组间脐静脉血pH值、PCO₂、PO₂和SO₂比较差异无统计学意义。3组产妇出血量、肠蠕动恢复时间、开始下床活动时间及平均住院天数相比较，Ⅰ组明显高于Ⅱ、Ⅲ组，Ⅱ、Ⅲ 2组比较差异无统计学意义；24 h宫高下降幅度、泌乳时间3组比较差异无统计学意义。与Ⅰ组比较，Ⅱ、Ⅲ组产妇尿潴留发生率低，病人睡眠情况好。Ⅱ组产妇满意度高于Ⅰ、Ⅲ组。结论 以0.125%罗哌卡因复合芬太尼2 μg/mL行硬膜外分娩镇痛可提供较为有效的镇痛，未见对新生儿及产妇有不良影响，是一种安全有效的分娩方式。

Effects of different delivery methods on maternal and fetal complications during labor

Objective To investigate the effects of 3 different delivery methods on maternal and fetal complications during labor and determine better mode of delivery. Methods Sixty pregnant women with ASA class Ⅰ or Ⅱ were randomly divided into three groups with 20 cases each: the cesarean section group (group Ⅰ), the pain relief group (group Ⅱ) and normal delivery group (group Ⅲ). In group Ⅰ and Ⅱ, an epidural catheter was placed through L2-3 interval. 0.5% ropivacaine was injected via the epidural catheter for continuous epidural anesthesia in group Ⅰ. After a loading dose of 8-10 mL 0.125% ropivacaine+2 μg/mL fentany, the patient-controlled epidural analgesia (PCEA) during labor was started with bolus 5 mL, lockout interval 20 min and back ground infusion rate 6-8 mL/h in group Ⅱ. The level of block was controlled below T10. BP, HR and RR were continuously monitored during labor. Blood samples were taken from umbilical vein at delivery for blood gas analysis and determination of lactate concentration. Neonates were assessed by Apgar score and neurological and adaptive capacity score (NACS). Maternal postoperative complications were recorded. Results There was no statistical differences in plasma pH, PCO₂, PO₂, SO₂, Apgar score and NACS among 3 groups. The umbilical vein blood lactate concentration was significantly increased in group Ⅱ and Ⅲ compared to the group Ⅰ, while blood lactate concentration in group Ⅱ was lower than that in the group Ⅲ (P<0.05). Base excess (BE) was significantly higher in group Ⅲ than in group Ⅰ. Compared with group Ⅱ and Ⅲ, maternal postoperative complications such as urinary retention, postpartum hemorrhage and so on were increased significantly in group Ⅰ (P<0.05). PCEA provided satisfactory effect in group Ⅱ. Conclusions Epidural labor analgesia with 0.125% ropivacaine+2 μg/mL fentany can provide comparative and effective analgesia for pain relief during labor without adverse effects on the mothers and fetuses and may reduce the postoperative complications. It is a safer and more effective technique in pain relief during labor.