硬膜外分娩镇痛联合体位指导在妊娠期糖尿病孕妇产程中的应用  

The application of epidural labor analgesia combined with postural guidance in the labor process of pregnant women with gestational diabetes mellitus

作　　者：杨秋玲 吕卫娜 孙爱莲 孙倩 袁晓茹 李萌盟 李红 YANG Qiuling;LV Weina;SUN Ailian(The Sixth People’s Hospital of Hengshui City,Hebei,Hengshui 053000,China)

机构地区：[1]河北省衡水市第六人民医院

出　　处：《河北医药》2020年第3期402-405,共4页Hebei Medical Journal

摘　　要：目的探讨硬膜外分娩镇痛冲击量给药联合以改良腰麻侧卧位为主的待产体位对妊娠期糖尿病产妇产程、疼痛、血糖、分娩结局及新生儿的影响。方法选择2018年1~12月预计可阴道分娩的212例妊娠期糖尿病孕妇作为研究对象,按就诊卡单双号分为试验组和对照组,每组106例。对照组孕妇临产后采用导乐护理,拉玛泽呼吸方法减痛,同时用孕妇自觉舒适的体位进行待产。试验组孕妇临产后对孕妇进行体位指导,采用以改良腰麻侧卧位为主,以坐位、立位为辅的待产体位。并采用硬膜外分娩镇痛,给予冲击量罗哌卡因。比较2组产妇的产程时限、血糖波动、分娩结局、镇痛满意度及新生儿评分、脐动脉血气、血糖情况。结果试验组产程时间、自然分娩率、镇痛满意度、血糖水平、产后出血、新生儿血糖均优(少)于对照组,差异有统计学意义(P<0.05)。结论硬膜外分娩镇痛联合体位管理,能缩短产程,减轻妊娠期糖尿病孕妇产程中的血糖波动,避免新生儿低血糖发生,分娩镇痛效果确切,促进自然分娩,对母儿无不良影响,安全可靠,操作简单,易于掌握,产妇乐于接受,特别适用于基层医院推广应用。Objective To explore the effects of epidural labor analgesia combined with improved lateral decubitus position under lumbar anesthesia on delivery process,pain,blood sugar,delivery outcome of parturients with gestational diabetes mellitus(GDM)and its effects on neonates.Methods A total of 212 pregnant women with gestational diabetes mellitus who were expected to have vaginal delivery in our hospital from January 2018 to December 2018 were divided into experimental group(n=106)and control group(n=106)according to the number of visiting cards.The patients in control group were given Doula nursing.Lamaze breathing method was used to relieve pain while pregnant women were awaiting delivery in a comfortable position.The patients in experimental group were given parturient posture guidance,with improved lateral decubitus position under lumbar anesthesia as main position and sitting and standing posture as auxiliary.And the patients were given epidural labor analgesia by impulse ropivacaine.The duration of labor,blood sugar fluctuation,delivery outcome,satisfaction with analgesia,neonatal score,umbilical artery blood gas and blood sugar were compared between the two groups.Results The duration of labor,natural delivery rate,satisfaction with analgesia,blood sugar level,postpartum hemorrhage and neonatal blood sugar in experimental group were superiot to those in control group(P<0.05).Conclusion The epidural labor analgesia combined with posture management can shorten the labor process,alleviate the fluctuation of blood sugar during the labor of pregnant women with gestational diabetes mellitus,avoid the occurrence of neonatal hypoglycemia and promote natural delivery,with exact effect of labor analgesia and without adverse effects on mothers and children.It is safe,simple and reliable and can be widely used in primary hospitals.

关 键 词：改良腰麻侧卧位 罗哌卡因 冲击量给药 分娩镇痛 妊娠期糖尿病 

分 类 号：R587.1[医药卫生—内分泌]