无痛分娩对妊娠期高血压产妇围生期血液流变学和血小板活化状态的影响  

Effect of painless delivery on perinatal hemorheology and platelet activation status in parturients with gestational hypertension

作　　者：申彦敏 冯巧荣 李文政 江振龙 王小娟 张海芬 赵二梅 侯艳芳 任安虎 宋学平 SHEN Yanmin;FENG Qiaorong;LI Wenzheng(She County Hospital,Hebei,She 056400,China)

机构地区：[1]河北省涉县医院,056400 [2]河北省涉县妇幼保健院

出　　处：《河北医药》2023年第8期1174-1178,共5页Hebei Medical Journal

基　　金：河北省卫生健康委计划(编号:20200140)。

摘　　要：目的探讨无痛分娩对妊娠期高血压产妇的血液流变学影响。方法回顾性分析2019年1月至2020年12月行硬膜外分娩镇痛的110例妊娠高血压疾病产妇,随机分为无痛分娩组和常规分娩组。对所有产妇在分娩镇痛前实施胎心监测,常规分娩组进行常规的分娩,无痛分娩组给予无痛分娩。监测2组产妇镇痛期间生命体征变化,使用视觉模拟评分评价2组分娩疼痛情况,以血流变学分析仪检测2组血流变化(血浆黏度、全血黏度、全血还原黏度、血沉方程K值、血细胞比容、红细胞聚集指数)。以郭峰法检测血小板活化指标(CD61、GMP140、CD63)。结果于术前、镇痛后10 min、镇痛后20 min、镇痛后30 min、镇痛后60 min和分娩后对2组生命体征指标进行比较,无痛分娩组的心率、血压、脉搏血氧饱和度变化幅度均小于常规分娩组(P<0.05)。镇痛开始前2组疼痛评分无差异(P>0.05)。在镇痛开始后10 min,20 min时,无痛分娩组的疼痛评分优于常规分娩组(P<0.05)。在宫口扩张至7~8 cm时,2组产妇的VAS评分相比较,差异无统计学意义(P>0.05)。及至宫口扩张至10 cm时,无痛分娩组产妇的VAS评分均低于常规分娩组产妇(P<0.05)。镇痛前2组血液黏度指标(血浆黏度、全血黏度及全血还原黏度、血沉方程K值、血细胞比容及红细胞聚集指数)和血小板活化状态指标(CD61、GMP140及CD63)差异无统计学意义(P>0.05),宫口开全时及产后10 min 2组血液黏度均先升后降,且无痛分娩组均显著高于常规分娩组(P<0.05)。结论妊娠高血压疾病患者发生凝血的风险级别更高,通过监测血液流变学指标的变化可指导该类患者的诊疗,以减少患者分娩风险,同时无痛分娩对妊娠期高血压疾病产妇围生期血流变化和血小板活化状态的影响相对较小,应用价值较高。Objective To investigate the effect of painless delivery on perinatal hemorheology and platelet activation status in parturients with gestational hypertension.Methods A total of 110 pregnant women with gestational hypertension who underwent epidural labor analgesia in our hospital from January 2019 to December 2020 were analyzed retrospectively.They were randomly divided into painless delivery group and routine delivery group,and corresponding delivery mode was given.All parturients were monitored for fetal heart rate before labor analgesia.The changes of vital signs during analgesia were monitored,and the delivery pain of the two groups was evaluated by grading the visual analog scale(VAS)score.The blood flow changes of the two groups(plasma viscosity,whole blood viscosity,whole blood reducing viscosity,sedimentation equation Kvalue,hematocrit and erythrocyte aggregation index)were detected by Hemorheology analyzer.The platelet activation indexes(CD61,GMP140,CD63)were detected by Guo Feng method.Results The vital signs of the two groups were compared before operation,10 minutes,20 minutes,30 minutes and 60 minutes after analgesia and after delivery.The changes of heart rate,blood pressure and pulse oxygen saturation in painless delivery group were significantly smaller than those in routine delivery group(P<0.05).There was no difference in VAS score between the two groups before analgesia(P>0.05).At 10 and 20 minutes of analgesia,VAS score of painless delivery group was lower than that of routine delivery group(P<0.05).When the uterine orifice expanded to 7~8 cm,the VAS score was similar between groups(P>0.05).When the uterine orifice expanded to 10 cm,the VAS score in painless delivery group was significantly lower than that in routine delivery group(P<0.05).There were no significant differences in blood viscosity indexes(plasma viscosity,whole blood viscosity and whole blood reducing viscosity,sedimentation equation kvalue,hematocrit and erythrocyte aggregation index)and platelet activation indexes(CD61,GMP140

关 键 词：妊娠期高血压疾病 分娩 无痛 血液流变学 

分 类 号：R714.3[医药卫生—妇产科学] R714.246[医药卫生—临床医学]