栗树珺

[摘要] 目的 研究分析在足月妊娠宮颈成熟以及引产过程中运用常用的3种促宫颈成熟方法的效果以及安全性。方法 从2017年4—10月期间在该院产科被确诊为存在引产指征的单胎、头位但宫颈不成熟的足月产妇中方便选取96例，根据治疗方式的不同将其随机平均分成宫颈扩张水囊组32例，缩宫素组32例以及米索前列醇组32例。将3组患者治疗后的Bishop分数、临产消耗时间、产程时间、分娩情况以及产后结局进行对比。结果 在Bishop分数方面，宫颈扩张水囊的分数（8.2±0.8）分显著比另外两组要高（5.2±0.13）分、（6.9±0.7）分差异有统计学意义（P<0.05），而临产耗时方面米索前列醇组（16.11±4.43）h则是显著比另外两组要低（20.21±4.87）h、（53.11±20.12）h差异有统计学意义（P<0.05），在第一产程方面宫颈扩张水囊组（4.53±1.17）h则是显著短于另外两组（7.25±2.13）h、（6.74±2.38）h差异有统计学意义（P<0.05），在总产程、阴道分娩率方面，宫颈扩张水囊组（7.65±3.11）h、81.25%以及米索前列醇组（8.11±2.87）h、78.12%之间差异无统计学意义（P>0.05），但两组均显著比缩宫素组（11.11±3.43）h、62.5%要高差异有统计学意义（P<0.05）。宫缩强度方面米索前列醇组患者（12.50%）显著比另外两组要高（0.00%）、（3.16%）差异有统计学意义（P<0.05）。而在产后出血以及新生儿Apgar方面3组之间（9.4±0.5）分、（9.3±0.4）分、（9.4±0.4）分均差异无统计学意义。 结论 宫颈扩张水囊、米索前列醇均有良好的改善宫颈成熟的效果，其中宫颈扩张水囊安全性更好，但价格昂贵，普遍患者有异物感，而米索前列醇效果也较好、引产较快并且价格低廉、使用方便，但应用时需严密监测产妇和胎儿情况。

[关键词] 促宫颈成熟；妊娠晚期；缩宫素；宫颈扩张水囊；米索前列醇；效果

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2018）03（a）-0042-03

Comparison of Three Methods on Promoting Cervical Mature in Late Pregnancy

LI Shu-jun

Department of Gynaecology and Obstetrics， Kunming Panlong District Peoples Hospital， Kunming， Yunnan Province， 650000 China

[Abstract] Objective This paper tries to study the effect and safety of using three commonly used methods of cervical ripening in term pregnancy cervical ripening and induction of labor. Methods From April to October 2017， 96 patients were convenient selected from the unmarried full-term mothers with single-fetus and head-top but immature cervix in obstetric department of obstetrics who were diagnosed as having induced abortion. According to the different treatment methods， they were randomly divided into three groups， 32 cases of cervical dilatation balloon group， oxytocin group 32 cases and misoprostol group 32 cases. The Bishop scores， labor-consumption time， labor duration， delivery status， and post-natal outcomes were compared between the three groups after treatment. Results In terms of Bishop score， the score of cervical dilatation balloon （8.2±0.8）points was significantly higher than that of the other two groups （5.2±0.13）points and （6.9±0.7）points the difference was statistically significant （P<0.05）， respectively. However， misoprostol （16.11±4.43）h was significantly lower than the other two groups （20.21±4.87）h， （53.11±20.12） h the difference was statistically significant（P<0.05）， in the first stage of labor cervical dilatation and hydatid group（4.53±1.17）h， significantly shorter than the other two groups of （7.25±2.13）h and （6.74±2.38）h the difference was statistically significant（P<0.05），In tems of total labor and vaginal delivery（7.65±3.11）h and 81.25% of the patients in the cervical dilatation were no significantly difference of（8.11±2.87） h and 78.12% in the misoprostol group （P>0.05）， but both groups were significantly higher than those in the oxytocin group （11.11±3.43）h and 62.5%the difference was statistically significant（P<0.05）. In terms of contractility， patients in the misoprostol group（12.50%） were significantly higher（0.00%） than those in the other two groups（3.16%）the difference was statistically significant（P<0.05）. There was no significant difference between the three groups in terms of postpartum hemorrhage and neonatal Apgar （9.4±0.5）points， （9.3±0.4）points and （9.4±0.4）points. Conclusion Cervical dilatation of the water sac， misoprostol have a good cervical maturation effect， which is more safe cervical dilatation balloon， but the price is expensive， the general patient has foreign body sensation， and misoprostol effect is better， induced labor faster and cheaper， easy to use， but the application requires close monitoring of maternal and fetal conditions.

[Key words] Promote cervical ripening； Late pregnancy； Oxytocin； Cervical dilatation balloon； Misoprostol； Effect

部分孕妇在妊娠晚期由于妊娠合并症、并发症、胎儿因素或妊娠超过41周之后未能自行发动有效的宫缩，需要进行人为干预结束妊娠，而宫颈成熟度是影响引产能否成功的关键因素，临床上促进宫颈成熟的目的就是使宫颈变软、发生扩张，缩短引产时间、降低引产失败率，如果产妇引产的指标明确，但是宫颈成熟度不够，则需要采取一定的临床措施来促进宫颈成熟，这样可有效降低剖宫产的风险。该次研究主要目的在于探讨对于晚期妊娠的患者如何使用更好的促宫颈熟引产的方法[1]。对该院2017年4—10月期间以来使用的各类方法如缩宫素、宫颈扩张水囊、米索前列醇等引产方法进行分类汇总并分析总结，现报道如下。……