孙丹丹++++++蔡玉娟++++++张望平

[摘要] 目的 观察Cook宫颈扩张球囊联合硬膜外镇痛在足月引产中的临床效果。 方法 选择2013年3月～2014年8月嘉兴妇幼保健院足月初产妇80例为研究对象，将其随机分为观察组与对照组，每组40例。观察组在Cook宫颈扩张球囊联合硬膜外镇痛下引产，对照组单纯采用Cook宫颈球囊引产。观察产程时间、产程结局、血流动力学指标、出血量、新生儿Apgar评分及不良反应，采集新生儿脐动脉血血气分析，测定引产前及分娩后例组产妇血常规白细胞计数和超敏C反应蛋白，总体评价产妇分娩舒适度。 结果 观察组第一产程潜伏期明显短于对照组[（196.60±65.48）比（242.80±78.62） min]，差异有高度统计学意义（P < 0.01），且观察组疼痛减轻；两组产程结局、出血量、新生儿Apgar评分、脐动脉血血气分析、引产术前及分娩后白细胞、超敏C反应蛋白比较，差异无统计学意义（P > 0.05）。两组收缩压、舒张压、心率比较，差异均有统计学意义（P < 0.05或P < 0.01），注药后0.5、1、2、3、4 h及结束时观察组视觉模拟评分均明显低于对照组（P < 0.05或P < 0.01）。 结论 Cook宫颈扩张球囊联合硬膜外镇痛在足月引产中能明显缩短第一产程，减轻产妇疼痛，不增加感染概率，是一种安全有效的方法，可临床推广应用。

[关键词] 宫颈扩张球囊；引产；硬膜外；镇痛

[中图分类号] R719 [文献标识码] A [文章编号] 1673-7210（2015）10（b）-0063-04

Effect of Cook balloon cervical dilator combined with epidural analgesia on full-term nulliparous parturients

SUN Dandan1 CAI Yujuan1 ZHANG Wangping1▲

1.Department of Obstetrical， Jiaxing Maternity and Child Health Care Hospital， Zhejiang Province， Jiaxing 314000， China； 2.Department of Anesthesiology， Jiaxing Maternity and Child Health Care Hospital， Zhejiang Province， Jiaxing 314000， China

[Abstract] Objective To explore the feasibility and effect of Cook balloon cervical dilator with epidural analgesia on full-term nulliparous parturients. Methods A total of 80 nulliparous parturients in Jinxing Maternity and Child Health Care Hospital from March 2013 to August 2014 were selected as study objects， and they were randomly divided into two groups， observation group （n=40） were received Cook balloon cervical dilator combined with epidural analgesia and control group （n=40） were received no epidural analgesia. The stage of labor， delivery outcome， parameters of hemodynamics， haemorrhage， Apgar scores of neonate and side effects were recorded. WBC and hypersensitive C-reactive protein of puerperas prenatal and after delivery were measured and blood gas analysis of umbilical artery blood of newborns was carried. Results Latent phase of lalor was shorter in observation group than in control group [（196.60±65.48） vs （242.80±78.62） min] （P < 0.01）. Moreover， the pain was relieved obviously. There were no significant differences in other labor duration， delivery outcome， haemorrhage， and Apgar scores between two groups （P > 0.05）. SBP， DBP， HR of two groups had statistically significant differences （P < 0.05 or P < 0.01）； 0.5， 1， 2， 3， 4 h after given medicine and the end of delivery， VAS scores of the observation group were significantly lower than those of the control group， the differences were statistically significant （P < 0.05 or P < 0.01）. Conclusion Cook balloon can shorten latent phase of lalour， relieve the pain of parturients and not increase infection rate， it is worth the clinical application.

[Key words] Balloon cervical dilator； Induced labor； Epidural； Analgesia

Cook宫颈扩张球囊是一种无菌硅胶双球囊，它通过水囊产生温和的机械性扩张力促进宫颈成熟，同时刺激内源性前列腺素释放，从而使产妇逐渐扩张宫颈，使产程进展迅速[1]。若产程过长会对胎儿带来不利影响，如胎儿缺氧、新生儿免疫力低下、母婴感染、新生儿肺炎、败血症等。然而Cook宫颈扩张球囊引产后疼痛较为剧烈，因此本研究将Cook宫颈扩张球囊联合硬膜外镇痛应用于足月初产妇，现报道如下：

1 资料与方法

1.1 一般资料

选择2013年3月～2014年8月嘉兴市妇幼保健院80例产妇为研究对象，所有产妇均超预产期、单胎头位，ASA I～Ⅱ级。年龄22～35岁，平均（26.8±4.45）岁；身高155～171 cm，平均（159.8±3.26）cm；体重54～81 kg，平均（74.6±8.72）kg；孕龄40～42周，平均（40.8±0.65）周。……