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目的探讨硬膜外分娩镇痛对妊娠期糖尿病(GDM)产妇母婴的影响。方法选择151例GDM初产妇为研究对象,其中84例接受硬膜外分娩镇痛者为实验组,67例未接受分娩镇痛者为对照组。比较两组的各产程持续时间、催产素使用率、产钳助产率,比较两组新生儿的1 min Apgar评分、脐带血皮质醇水平和血糖。检测两组产妇在T_0(产前)、T_1(规律宫缩时)、T_2(宫口开全)、T_3(胎儿娩出时)各时点的静脉血糖,以及T_0、T_3时间点的静脉血皮质醇水平。结果两组的各产程时间和产钳助产率无显著差异(P>0.05),实验组的催产素使用率显著高于对照组(P<0.05)。实验组在T_2、T_3时点的静脉血糖明显低于对照组(P<0.01),T_3时点的血皮质醇浓度明显低于对照组(P<0.01)。两组新生儿Apgar评分无显著差异(P>0.05),实验组新生儿血糖显著高于对照组,脐带血皮质醇浓度显著低于对照组(P<0.01)。结论硬膜外自控分娩镇痛对产程无明显影响,且可有效减轻GDM产妇分娩过程中血糖及皮质醇的波动,改善新生儿血糖。
Objective To investigate the effect of epidural analgesia on mothers and infants in gestational diabetes mellitus (GDM). Methods 151 cases of GDM primiparous women were selected as the research object, of which 84 cases received epidural labor analgesia as experimental group, 67 cases did not receive labor analgesia as control group. Duration of each birth course, oxytocin use rate, forceps delivery rate, 1-minute Apgar score, umbilical cord cortisol level, and blood glucose were compared between the two groups. The venous blood glucose of the two groups were detected at T0 (prenatal), T_1 (regular contractions), T_2 (cervicocele) and T_3 (at the time of fetus delivery), and venous cortex at T_0 and T_3 Alcohol level. Results There was no significant difference in labor time and forceps yield between the two groups (P> 0.05). The oxytocin utilization rate in the experimental group was significantly higher than that in the control group (P <0.05). Compared with the control group, the blood glucose in the experimental group at T 2 and T 3 was significantly lower than that in the control group (P <0.01). The plasma cortisol level at T 3 was significantly lower than that of the control group (P <0.01). There was no significant difference in Apgar score between the two groups (P> 0.05). The neonatal blood glucose of the experimental group was significantly higher than that of the control group, and the cord blood cortisol concentration was significantly lower than that of the control group (P <0.01). Conclusion Epidural labor-controlled labor analgesia has no significant effect on labor process, and can effectively reduce the blood sugar and cortisol fluctuations during delivery of GDM maternal and improve neonatal blood glucose.