人工破膜術(shù)對(duì)分娩結(jié)局及母嬰的影響

劉振榮1，謝娟2

(1.徐州市銅山區(qū)中醫(yī)院 婦產(chǎn)科，江蘇 徐州 221116;2.南華大學(xué)附屬第三醫(yī)院婦產(chǎn)科，湖南 衡陽(yáng) 421001)

摘要：目的探討人工破膜和胎膜自然破裂對(duì)分娩結(jié)局以及母嬰的影響。方法對(duì)正常分娩的初產(chǎn)婦100例臨床資料進(jìn)行回顧分析，將實(shí)施人工破膜的產(chǎn)婦50例設(shè)為治療組；另50例胎膜自然破裂產(chǎn)婦設(shè)為對(duì)照組，比較2組產(chǎn)婦的分娩結(jié)局、羊水性狀、經(jīng)陰道分娩各產(chǎn)程時(shí)間、產(chǎn)后2 h出血量及分娩后并發(fā)癥發(fā)生情況，并比較2組新生兒窒息、產(chǎn)瘤的發(fā)生率及并發(fā)癥情況。結(jié)果治療組產(chǎn)婦的剖宮產(chǎn)率明顯低于對(duì)照組(P<0.05)；治療組產(chǎn)婦陰道分娩率明顯高于對(duì)照組(P<0.05)；治療組新生兒窒息的發(fā)生率明顯低于對(duì)照組(P<0.05)；治療組產(chǎn)婦羊水污染的發(fā)生率明顯低于對(duì)照組(P<0.05),而新生兒產(chǎn)瘤率高于對(duì)照組(P<0.05)；治療組產(chǎn)婦分娩后并發(fā)癥及新生兒并發(fā)癥發(fā)生率明顯低于對(duì)照組(P<0.05)。結(jié)論人工破膜分娩可加速產(chǎn)婦產(chǎn)程進(jìn)展，提高自然分娩率,并可有效改善分娩結(jié)局。

關(guān)鍵詞：胎膜自然破裂；人工破膜；分娩結(jié)局；新生兒窒息

DOI:10.13463/j.cnki.cczyy.2015.06.069

中圖分類號(hào)：R271.9文獻(xiàn)標(biāo)志碼：A

文章編號(hào)：2095-6258(2015)06-1285-03

基金項(xiàng)目：湖南省教育廳科技計(jì)劃項(xiàng)目(13B098)。

作者簡(jiǎn)介：劉振榮(1971-)，女，大學(xué)本科，副主任醫(yī)師，主要從事婦產(chǎn)科疾病研究。

收稿日期:(2015-08-31)

Artificial rupture of membrane on birth outcomes and the maternal and child health

LIU Zhenrong1, XIE Juan2

(1.Department of Obstetrics and Gynecology, Tongshan District Hospital of Traditional Chinese Medicine,

Xuzhou 221116, Jiangsu Province, China;

2.Department of Obstetrics and Gynecology, The Third Hospital Affiliated to University of South China,

Hengyang 421001, Hunan Province, China)

Abstract：ObjectiveTo explore the effect of artificial rupture of membrane and natural rupture of membrane on the birth outcomes and the maternal and child health. MethodsThe clinical materials of 100 primipara were retrospectively analyzed, among which 50 cases performed with artificial rupture of membrane were served as the observation group, while 50 cases with natural rupture of membrane were served as the control group. The birth outcomes, amniotic fluid character, each birth process time through vaginal delivery, amount of bleeding 2h after delivery, and complications in the two groups were compared. The occurrence rate of neonatal asphyxia and caput succedaneum, and the complications in the two groups were compared. ResultsThe cesarean section rate in the observation group was significantly lower than that in the control group (P<0.05). The vaginal deliver rate in the observation group was significantly higher than that in the control group (P<0.05). The amniotic fluid pollution rate in the observation group was significantly lower than that in the control group (P<0.05), while the neonatal caput succedaneum rate was significantly higher than that in the control group (P<0.05). The occurrence rates of postpartum complications and neonatal complications in the observation group were significantly higher than those in the control group (P<0.05). ConclusionThe artificial rupture of membrane can accelerate the birth process progress, enhance the natural delivery rate, and effectively improve the birth outcomes.

Keywords:natural rupture of membrane; artificial rupture of membrane; birth outcomes; neonatal asphyxia

胎膜自然破裂是正常分娩胎兒娩出前胎膜發(fā)生的自然破裂，是一種生理狀態(tài)分娩下的胎膜破裂[1]。人工破膜是利用人工的方法刺破胎膜的手術(shù)操作，在產(chǎn)科常用，對(duì)產(chǎn)程進(jìn)展起到明顯的促進(jìn)作用[2]。實(shí)施人工破膜還可在早期對(duì)產(chǎn)婦的羊水情況進(jìn)行觀察，了解產(chǎn)婦羊水胎糞污染的程度、胎兒宮內(nèi)窘迫程度，使新生兒窒息率明顯降低[3]。有研究[4]證實(shí)，人工破膜分娩對(duì)縮短產(chǎn)程及降低妊娠不良結(jié)局均十分有利。另有學(xué)者[5]認(rèn)為，在分娩活躍早期行人工破膜不僅可使產(chǎn)程加速，還有利于降低新生兒窒息的發(fā)生率。本研究對(duì)比了人工破膜和胎膜自然破裂對(duì)分娩結(jié)局及母嬰預(yù)后的影響?，F(xiàn)將結(jié)果報(bào)告如下。

1資料與方法

1.1一般資料對(duì)2013年1月—2014年12月于我院正常分娩的初產(chǎn)婦100例臨床資料進(jìn)行回顧分析，其中實(shí)施人工破膜的產(chǎn)婦50例設(shè)為治療組，年齡23～35歲，平均(28.6±2.2)歲，孕38～42周，平均(40.2±1.0)周，胎兒體質(zhì)量2.7～4.5 kg，平均(3.5±0.5) kg；另50例胎膜自然破裂產(chǎn)婦設(shè)為對(duì)照組，年齡22～36歲，平均(28.1±2.4)歲，孕37～41周，平均(39.5±0.8)周，胎兒體質(zhì)量2.8～4.3 kg，平均(3.4±0.6) kg。2組產(chǎn)婦經(jīng)B超檢查顯示均為單胎、頭位，納入本研究的產(chǎn)婦均無(wú)臍帶先露、頭盆不稱、產(chǎn)道異常等妊娠并發(fā)癥。本研究經(jīng)醫(yī)院倫理委員會(huì)認(rèn)可，產(chǎn)婦以及家屬均事先知情并同意接受研究。1.2治療方法對(duì)照組待產(chǎn)產(chǎn)婦等待胎膜自然破裂分娩，待產(chǎn)過程中不給予其他干預(yù)措施。治療組產(chǎn)婦在宮口開大3～4 cm時(shí)實(shí)施人工破膜，人工破膜具體操作如下:產(chǎn)前囑產(chǎn)婦排空膀胱，取截石位，常規(guī)消毒，當(dāng)宮縮規(guī)律、宮頸口明顯擴(kuò)張至3 cm時(shí)，可對(duì)產(chǎn)婦實(shí)行人工破膜處理，人工破膜選擇在宮縮間歇期及下次宮縮開始前進(jìn)行，將9號(hào)針頭在宮縮間歇期即2次宮縮之間送入陰道內(nèi)，利用9號(hào)針頭刺破羊膜囊，刺破過程中注意保持適度的破口大小，將有齒鉗伸入陰道內(nèi)鉗夾住胎膜并將其撕破，胎膜撕破后將手伸入陰道內(nèi)，不僅利于羊水的緩慢流出，還可使胎膜緊貼胎頭表面，羊水流出過程中醫(yī)生需傾聽胎心音、胎動(dòng)情況，若2次宮縮后，胎兒出現(xiàn)胎頭下降并進(jìn)入盆腔內(nèi),且無(wú)臍帶脫垂的發(fā)生，此時(shí)醫(yī)生可緩慢退出手；破膜完成后囑咐產(chǎn)婦放平臀部，并采用胎心監(jiān)護(hù)儀持續(xù)監(jiān)測(cè)產(chǎn)婦的宮縮情況及胎心音變化情況。若破膜后產(chǎn)婦出現(xiàn)羊水污染，可結(jié)合產(chǎn)婦產(chǎn)程進(jìn)展情況制定分娩計(jì)劃。1.3觀察指標(biāo)采用Apgar評(píng)分法對(duì)2組新生兒窒息情況進(jìn)行評(píng)分，比較2組產(chǎn)婦的分娩結(jié)局、各產(chǎn)程時(shí)間、產(chǎn)后2 h出血量及分娩后并發(fā)癥情況[6]。對(duì)2組產(chǎn)婦的羊水污染情況進(jìn)行判斷[7]。對(duì)2組新生兒窒息發(fā)生率、產(chǎn)瘤發(fā)生率進(jìn)行比較[8]。1．4統(tǒng)計(jì)學(xué)方法研究數(shù)據(jù)采用SPSS 13.0統(tǒng)計(jì)學(xué)軟件分析，計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(±s)表示，計(jì)數(shù)資料以百分比表示，2組間計(jì)量資料比較進(jìn)行t檢驗(yàn)，計(jì)數(shù)資料比較采用χ2檢驗(yàn)，P<0.05 表示差異有統(tǒng)計(jì)學(xué)意義。

2結(jié)果

2.12組新生兒1 min Apgar評(píng)分情況及新生兒窒息發(fā)生率比較見表1。

表1　2組新生兒1min Apgar評(píng)分情況及新生兒窒息發(fā)生率比較( n=50)例(%)

注：與對(duì)照組比較，#P<0.05

2.22組產(chǎn)婦的分娩結(jié)局比較見表2。

表2　2組產(chǎn)婦的分娩結(jié)局比較( n=50)　 例(%)

注：與對(duì)照組比較，#P<0.05

2.32組產(chǎn)婦分娩后羊水污染情況及新生兒產(chǎn)瘤情況比較見表3。

表3　2組產(chǎn)婦分娩后羊水污染情況及新生兒產(chǎn)瘤情況比較( n=50)例(%)

注：與對(duì)照組比較，#P<0.05

2.42組母嬰并發(fā)癥情況比較治療組產(chǎn)婦分娩后并發(fā)癥及新生兒并發(fā)癥發(fā)生率顯著低于對(duì)照組(P<0.05)。

3結(jié)語(yǔ)

人工破膜在活躍早期應(yīng)用的主要作用機(jī)制是增加前列腺素、縮短宮頸全開時(shí)間、增強(qiáng)宮縮、縮短產(chǎn)程等，對(duì)于胎膜自然破裂前出現(xiàn)羊水污染的產(chǎn)婦，及時(shí)行人工破膜可減少胎兒宮內(nèi)窘迫、窒息等并發(fā)癥的發(fā)生[9-15]。本研究結(jié)果提示,人工破膜術(shù)在活躍早期的應(yīng)用具有縮短產(chǎn)程，提高自然分娩率，降低新生兒窒息率及母嬰并發(fā)癥發(fā)生率等優(yōu)勢(shì)，但可增加新生兒產(chǎn)瘤發(fā)生概率，臨床應(yīng)根據(jù)產(chǎn)婦具體情況選擇合適的分娩破膜方式。

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