不同分娩方式对孕妇产后早期认知功能的影响  

Influence on the cognitive function of different delivery mode in early periods

作　　者：阳永宪[1] 朱昭琼[1] 刘兴奎[1] 张帆[1] 刘书明[1] 张超[1] 

机构地区：[1]遵义医学院附属医院麻醉科,贵州遵义563003

出　　处：《中国医药科学》2013年第19期9-11,20,共4页China Medicine And Pharmacy

基　　金：山东鲁南制药集团项目(遵鲁药[2010]001);贵州省高层次人才科研特助项目(TZJF-2008年60号)

摘　　要：目的探讨剖官产和自然分娩两种分娩方式对孕妇产后早期认知功能的影响。方法77例ASAI-Ⅱ级住院分娩孕妇，根据分娩方式的不同分为自然分娩组（A组）和剖宫产组（B组）。两组产前进行简易智力量表（mini—mentalstateexamination，MMSE）评分；评定精神和睡眠状况；记录有无妊娠期合并症。A组为自然分娩，B组行椎管内麻醉及剖宫产术，并术后均予舒芬太尼统一配方静脉镇痛，两组于产后1d、3d行认知状况和疼痛视觉模拟评分（visualanalogicscale，VAS）调查，比较两组术后早期认知功能障碍发生情况，分析可能的相关影响因素。结果（1）两组产后1d均有早期认知功能障碍的发生，B组发生率高于A组（B组20％；A组9．4％）；B组产后3d有1例（2．2％）发生认知功能障碍，A组无，两组差异无统计学意义；（2）孕妇产前大部分存在精神紧张（A组59．38％；B组55．56％），睡眠欠佳（A组75．00％；B组62．22％），但两组比较，差异无统计学意义；（3）两组年龄、孕产次、民族、文化程度、妊娠合并症等一般情况的比较均无统计学意义（P〉0．05）；（4）两组产前、产后1d、3d的MMSE评分及VAS评分比较，差异无统计学意义；（5）两组产时观察指标的比较：B组出血量明显大于A组A组（273．59±86．55）mL、B组（371．11±173．69）mL；术中低血压的发生率B组明显大于A组，B组12例（26．67％），A组0例（0％），两组比较均有统计学差异（P〈0．05）.结论产妇术后早期认知功能障碍的发生与分娩方式无关，可能与孕妇精神和妊娠后期睡眠状况、妊娠合并症、麻醉、手术、术中出血量增加和低血压、术后镇痛等因素有关。Objective To explore difference of cognitive function in early periods between cesarean section and natural birth maternity patients. Methods 77 ASA I -II pregnant women who gave birth at hospital were divided into cesarean section group（A group） and natural birthgroup（B group） according to different delivery modes, patients Resident maternity patients,the cognitive function scores were evaluated before delivery by MMSE;evaluating their mental conditions and sleep states.Patients in group B were given unified Sufentanil analgesia recipe postoperatively.both groups were investigated about cognitive function and VAS scores at ld,3d after delivery,comparing the happen of cognitive dysfunction and searching for possible relative reasons. Results （1）Both groups had postpartum cognitive dysfunction at the ld. The cognitive dysfunction in group B was higher than that of group A（B group 20%;A group 9.4%）;one case of B group（2.2%） has cognitive dysfunction at the 3d after delivery,none in group A.There were no significant difference between two groups. （2）Most of the pregnant women had symptoms as nervous（A group 59.38%;B group 55.56%）,dyssomnia（A group 75%; B group 62.22%）, there was no significance.（3）Comparing the ante partum conditions：there were no significance in age,peoples,degree of literature,pregnancy complications and so on （P 〉 0.05）;（4）There were no significance in the MMSE and VAS score ante partum and ld,3d post partum between 2 groups.（5）The amount of blood loss in group B during delivery was significantly higher than that of group A（273.59 ± 86.55mL,371.11 ± 173.69mL）.Intraoperative hypotension rate of group B was much higher than that of group A.12 cases in group B（26.67%）,none in group A（0%）（ P 〈 0.05）. Conclusion The incidences of cognitive dysfunction in puerpera are unrelated with the delivery mode,which may be related with pregnant women mental state and latter of gestation dyssomnia, pregnant complications, anesthesia,operation

关 键 词：分娩方式 认知功能障碍 

分 类 号：R714[医药卫生—妇产科学]