人工破膜联合安定在产程活跃期停滞应用.docVIP

人工破膜联合安定在产程活跃期停滞应用【摘要】 目的 探讨人工破膜联合安定（地西泮）在产程活跃期停滞的的疗效及对产程的影响。方法 采用人工破膜联合安定应用于88例诊断为协调性宫缩乏力、活跃期停滞的产妇作为观察组，同时抽取同期90例条件相似产程正常的产妇作为对照组。对两组资料进行分析比较。结果 人工破膜联合安定加速宫口扩张，缩短产程效果显著(P0.05)，对产后出血发生率差异无统计学意义(P0.05)。结论 人工破膜联合安定治疗协调性宫缩乏力、活跃期停滞效果显著，对促进产程进展效果肯定，且可降低剖宫产率。? 【关键词】 人工破膜;安定;产程 ?? The artificial broken membrane union Diazepam the application which stagnates in the course of childbirth active phase WANG Xin. Department of Gynecology and Obstetrics， 13th Peopl’se Hospital of Chongqing City，Chongqing 400053，China ? 【Abstract】 Objective Discusses the artificial broken membrane union Diazepam stagnates in the course of childbirth active phase the curative effect and to the course of childbirth the influence. Methods Used the artificial broken membrane union Diazepam to apply in 88 example diagnoses shrinks the parturient woman for the coordinative palace who the asthenia, the active phase stagnate were taken in observation group, simultaneously extracts the same time 90 example condition similar course of childbirth normal parturient woman were taken in the control group. Carried on the analysis comparison to two groups of materials. Results The artificial broken membrane union Diazepam acceleration palace mouth expansion, reduced the course of childbirth effect obviously (P0.05)。? 2.5 新生儿窒息发生情况 观察组有1例轻度窒息,占1.14%,无重度窒息及新生儿死亡。对照组有2例轻度窒息,占2.23%;重度窒息1例,占1.11%,无新生儿死亡。两组间新生儿窒息发生率有比较差异无统计学意义(P0.05)。? 3 讨论? 3.1 通过观察 活跃期人工破膜加安定静脉推注对分娩效果影响很大。明显缩短产程,平均缩短4.97 h,差异有统计学意义。很大程度上减轻产妇分娩疼痛时间,减轻分娩痛苦,减少体力消耗,而对新生儿预后、产后出血无明显影响。? 3.2 人工破膜后,随着羊膜囊的消失,胎头可直接接触并压迫宫颈,刺激宫颈旁神经丛,反射性地加强了子宫收缩的起博点,并使垂体后叶素分泌增加,催产素释放也相应增加,增强了子宫肌对催产素的反应性,从而进一步加强了子宫收缩的强度［1，2］,促进产程进展。破膜后,还有利于观察羊水性状, 了解胎儿宫内情况,及时发现问题并及时处理。? 3.3 安定促进产程主要有两方面作用。? 3.3.1 安定一方面具有中枢性肌肉松弛作用,能对抗各种痉挛，能显著抑制宫颈肌细胞内外钙离子的收缩反应,而选择性使子宫颈平滑肌松弛,尤其在分娩活跃期,可明显选择性地使宫颈肌纤维松弛,有效地软化宫颈,利于宫口扩张［3］。从而促进产程进展。? 3.3.2 安定具有镇静、催眠作用,且脂溶性高,静脉推注后可迅速进入脑组织,很快出现神经系统的抑制作用而减轻由于强烈宫缩时对大脑的不良刺激,用药后产妇安静朦胧入睡,休息片刻后疲劳逐渐消失。有利于产妇保持体力,从而保证产程顺利进展。产妇临产后,特别是初产妇,由于