低风险待产妇产程中口服营养补充对分娩结局影响的回顾性分析  

Retrospective analysis of the effect of oral nutritional supplements during labor on delivery outcomes in low-risk pregnant women

作　　者：苏晓娅 魏琳娜[2] 宋琪 周锋 徐孥 孙海岚 Su Xiaoya;Wei Linna;Song Qi;Zhou Feng;Xu Nu;Sun Hailan(Department of Clinical Nutrition,Chongqing Health Center for Women and Children(Women and Children's Hospital of Chongqing Medical University),Chongqing 401147,China;Department of Obstetrics and Gynecology,Chongqing Health Center for Women and Children(Women and Children's Hospital of Chongqing Medical University),Chongqing 401147,China)

机构地区：[1]重庆市妇幼保健院(重庆医科大学附属妇女儿童医院)临床营养科,401147 [2]重庆市妇幼保健院(重庆医科大学附属妇女儿童医院)妇产科,401147

出　　处：《中华临床营养杂志》2023年第4期208-212,225,共6页Chinese Journal of Clinical Nutrition

摘　　要：目的探讨低风险待产妇在自然分娩产程中口服营养补充(oral nutritional supplements,ONS)对分娩结局的影响以及中转剖宫产的危险因素。方法回顾性分析2022年3月15日至2022年5月15日于重庆市妇幼保健院分娩中心待产的单胎头位足月初产妇206例,助产士均给予统一的饮食指导,产程中口服了由临床营养科配制的分娩肠内营养液为ONS组(n=110),未口服分娩肠内营养液者为对照组(n=96)。比较两组待产妇的基线资料和分娩结局差异,并分析中转剖宫产的危险因素。结果ONS组和对照组待产妇在年龄、身高、基础体重、基础体重指数(body mass index,BMI)、孕期体重增加、产时BMI、孕周、椎管内分娩镇痛、产程缩宫素使用、胃肠道症状、新生儿身长和体重差异均无统计学意义(P>0.05),但ONS组待产妇在产程中经口摄入总能量显著高于对照组[(1349.99±569.51)kJ比(249.59±455.19)kJ,P<0.01]。ONS组待产妇的阴道分娩率显著高于对照组(93.6%比81.3%,P=0.01),其第一产程时长[(487.06±232.94)min比(416.17±191.13)min,P=0.03]也显著性高于对照组。ONS组产妇的第二产程时长、第三产程时长、会阴裂伤、宫颈裂伤、阴道裂伤、出血量、住院时间及新生儿出生后Apgar评分与对照组差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,年龄是待产妇中转剖宫产的独立危险因素(OR 1.20,95%CI 1.03~1.40,P=0.02),产程中进行ONS(OR 0.31,95%CI 0.11~0.85,P=0.02)和椎管内分娩镇痛(OR 0.10,95%CI 0.04~0.26,P<0.01)是待产妇中转剖宫产的保护因素。结论低风险待产妇在产程中ONS,可显著提高阴道分娩率,且未显著增加肠内营养胃肠不耐受发生。年龄是低风险待产妇中转剖宫产的危险因素,而产程中ONS和椎管内分娩镇痛是其保护因素。Objective To explore the effect of oral nutritional supplements(ONS)during labor on delivery outcomes in low-risk pregnant women and the risk factors of cesarean section.Methods A retrospective analysis was conducted in a total of 206 full-term pregnant women with singleton and cephalic presentation at the delivery center in our hospital from March 15th to May 15th,2022.Standard diet education was given to all those women by midwives.Pregnant women who received the enteral nutrient solution prepared by the Department of Clinical Nutrition during labor were in the ONS group(n=110),while those who did not were in the control group(n=96).The baseline characteristics and delivery outcomes were compared between the two groups,and the risk factors of cesarean section were also analyzed.Results There were no significant differences in terms of maternal age,height,baseline weight,baseline body mass index(BMI),weight gain during pregnancy,prenatal BMI,gestational week,intraspinal labor analgesia,oxytocin,gastrointestinal intolerance,neonatal length,and weight between the two groups(P>0.05).However,the total oral energy intake during labor in the ONS group was significantly higher than that in the control group([1349.99±569.51]kJ vs[249.59±455.19]kJ,P<0.01).The rate of vaginal delivery in the ONS group was significantly higher than that in the control group(93.6%vs 81.3%,P=0.01),and the duration of the first stage of labor([487.06±232.94]min vs[416.17±191.13]min,P=0.03)was also significantly longer in the ONS group.There were no significant differences between the two groups in terms of the duration of the second and third stages of labor,perineal laceration,cervical laceration,vaginal laceration,amount of bleeding,hospital stay,and Apgar score after birth(P>0.05).Multivariate logistic regression analysis showed that maternal age was a risk factor for changing to cesarean section in women with low-risk pregnancies(OR 1.20,95%CI 1.03 to 1.40,P=0.02),while ONS during labor(OR 0.31,95%CI 0.11 to 0.85,P=0.02)and intraspina

关 键 词：产程 口服营养补充 阴道分娩 分娩结局 危险因素 

分 类 号：R714.3[医药卫生—妇产科学]