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有研究认为阴道分娩过程中静脉输液可以缩短产程、降低剖宫产率，然而产程中静脉输液的管理尚无共识。临床工作中，分娩镇痛后常需给予短暂静脉输液预防低血压，本研究旨在评估持续静脉输液是否能改变初产妇的母儿结局。
采取前瞻性随机对照研究方法选取2020年7月至2020年12月在我院定期产检、足月单胎头位，要求阴道试产并行分娩镇痛的1548例初产妇为研究对象。分娩镇痛时常规开放静脉输液，孕妇可正常饮食，对照组的782例孕妇给予静脉输液250 mL/h，维持4 h；补液组的766例孕妇给予输液250 mL/h直至分娩。比较两组初产妇的产程时长及母儿结局。
①孕妇中转剖宫产率对照组为11.89%，补液组为14.62%（P = 0.116），产后出血率为5.12%和5.48%（P = 0.747），产妇均未出现肺水肿。②阴道分娩孕妇的第一产程、第二产程及总产程时限在对照组及补液组差异无统计学意义（P = 0.935，0.288，0.829），总产程 > 12 h发生率分别为36.28%和35.16%（P = 0.690），阴道分娩者产后出血率分别为5.08%和6.26%（P = 0.349）。③两组新生儿体重、1分钟Apgar评分 ≤ 7、新生儿住院率、羊水粪染率两组差异无统计学意义（P = 0.123，1.000，1.000，0.923）。
对于产程中饮食正常的初产妇，持续静脉输液并不能改善母儿结局，可仅给予分娩镇痛后常规静脉输液。
| 1 | Shrivastava VK， Garite TJ， Jenkins SM， et al. A randomized， double-blinded， controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas ［J］. Am J Obstet Gynecol， 2009， 200（4）： 379.e1. |
| 2 | Shafaie FS， Mohaddesi H， Mirghafourvand M， et al. A randomized， double-blinded，controlled trial comparing parenteral dextrose 5%， ringer′s solution and oral intake on the delivery outcomes in Nulliparas［J］. International Journal of Womens Health & Reproduction Sciences， 2017， 5（4）： 283. |
| 3 | Paré J， Pasquier JC， Lewin A， et al. Reduction of total labor length through the addition of parenteral dextrose solution in induction of labor in nulliparous： results of DEXTRONS prospective randomized controlled trial ［J］. Am J Obstet Gynecol， 2017， 216（5）： 508.e1. |
| 4 | Dawood F， Dowswell T， Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women ［J］. Cochrane Database Syst Rev， 2013（6）： CD007715. |
| 5 | 马彦彦， 庞汝彦. 正常产程中的入量管理 ［J］. 中华妇产科杂志， 2015， 50（4）： 316. |
| 6 | Practice guidelines for obstetric anesthesia： an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology ［J］. Anesthesiology， 2016， 124（2）： 270. |
| 7 | 沈晓凤， 姚尚龙. 分娩镇痛专家共识（2016版） ［J］. 临床麻醉学杂志， 2016， 32（8）： 816. |
| 8 | Hofmeyr GJ， Cyna AM， Middleton P. Prophylactic intravenous preloading for regional analgesia in labour［J］. Cochrane Database of Systematic Reviews， 2004（4）： CD000175. |
| 9 | Eslamian L， Marsoosi V， Pakneeyat Y. Increased intravenous fluid intake and the course of labor in nulliparous women ［J］. Int J Gynaecol Obstet， 2006， 93（2）： 102. |
| 10 | Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia ［J］. Am J Obstet Gynecol， 1946（52）： 191. |
| 11 | WHO. Care in normal birth： report of a technical working group ［J］. World Health Organization， 1997. |
| 12 | Committee on Obstetric Practice. Committee opinion No.687： approaches to limit intervention during labor and birth［J］. Obstet Gynecol， 2017， 129（2）： e20. |
| 13 | Garite TJ， Weeks J， Peters-Phair K， et al. A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women［J］. American Journal of Obstetrics and Gynecology， 2000， 83： 1544. |
| 14 | Edwards RK， Reed CA， Villano KS， et al. Effect of hydration on spontaneous labor outcomes in nulliparous pregnant women： a multicenter randomized controlled trial comparing three methods［J］. Am J Perinatol， 2014， 31（6）： 455. |
| 15 | Fong A， Serra AE， Caballero D， et al. A randomized， double-blinded， controlled trial of the effects of fluid rate and/or presence of dextrose in intravenous fluids on the labor course of nulliparas ［J］. American Journal of Obstetrics and Gynecology， 2017， 217（2）： 208. |
), 吴雪, 郑峥, 张慧珠, 赖毓冕()","risUrl_cn":"//www.pitakata.com/xuebao/CN/article/getTxtFile.do?fileType=Ris&id=134","title_cn":"产程中持续静脉输液对初产妇母儿结局的影响","doi":"10.3969/j.issn.2097-0005.2021.07.006","jieShuYe":"507","keywordList_en":["intravenous fluid","nulliparity","epidural analgesia","labor course","cesarean delivery"],"endNoteUrl_cn":"//www.pitakata.com/xuebao/CN/article/getTxtFile.do?fileType=EndNote&id=134","zhaiyao_en":"It is supposed that intravenous fluid infusion during vaginal delivery can shorten the duration of labor and reduce cesarean delivery rate. However， there is no consensus on the routine administration of intravenous fluids in labor. Shorter duration of intravenous infusion is routinely given after epidural analgesia to prevent hypotension， and this study is aimed to evaluate the effect of continuous intravenous fluid therapy on maternal and fetal outcomes in nulliparity.
The prospective randomized controlled study was made among 1548 nulliparous pregnant women who required vaginal delivery with epidural analgesia， singleton gestation and cephalic presentation at term in our hospital from July 2020 to December 2020. Intravenous infusion was routinely given after labor analgesia， and the pregnant women could choose normal diet， the control group including 782 women received 250 mL/h for 4 hours and the fluid infusion group including 766 women received 250 mL/h to fetal delivery. The duration of labor， maternal and fetal outcomes were compared between the two groups.
The cesarean conversion delivery rate was 11.89% in the control group and 14.62% in fluid infusion group （P = 0.116）， the total postpartum hemorrhage rates were 5.12% and 5.48% （P = 0.747）， there was no pneumonedema in both groups. The length of first stage of labor， second stage of labor and the total length of labor between the two vaginal delivery groups were not statistically significant （P = 0.935，0.288，0.829）. The total lengths of labor > 12 h was respectively 36.28% and 35.16% （P = 0.690）， and the vaginal delivery postpartum hemorrhage rates were 5.08% and 6.26% （P = 0.349）. There were no significant differences in neonatal birthweight， 1-minute Apgar ≤ 7， neonatal intensive care unit admission or meconium stained amniotic fluid between the two groups （P = 0.123，1.000，1.000， 0.923）.
Continuous intravenous fluid can not improve maternal and fetal outcomes with normal diet during labor， but just provide routine duration intravenous fluid after epidural analgesia.
), Xue Wu, Zheng Zheng, Huizhu Zhang, Yumian Lai()","risUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=Ris&id=134","title_en":"Effect of continuous intravenous fluid during labor on maternal and fetal outcomes of nulliparity","hasPdf":"true"},"authorNotes_cn":["沙晓燕，硕士，主治医师，主要从事妇产科临床诊治工作，E-amil：shaxiaoyan1015@163.com。","赖毓冕，硕士，主任医师，主要从事妇产科临床诊治工作，E-mail：lym7105@126.com。
产程中持续静脉输液对初产妇母儿结局的影响
沙晓燕, 吴雪, 郑峥, 张慧珠, 赖毓冕
betway必威登陆网址 (betway.com )学报››2021, Vol. 42››Issue (7): 504-507.
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产程中持续静脉输液对初产妇母儿结局的影响
Effect of continuous intravenous fluid during labor on maternal and fetal outcomes of nulliparity
有研究认为阴道分娩过程中静脉输液可以缩短产程、降低剖宫产率，然而产程中静脉输液的管理尚无共识。临床工作中，分娩镇痛后常需给予短暂静脉输液预防低血压，本研究旨在评估持续静脉输液是否能改变初产妇的母儿结局。
采取前瞻性随机对照研究方法选取2020年7月至2020年12月在我院定期产检、足月单胎头位，要求阴道试产并行分娩镇痛的1548例初产妇为研究对象。分娩镇痛时常规开放静脉输液，孕妇可正常饮食，对照组的782例孕妇给予静脉输液250 mL/h，维持4 h；补液组的766例孕妇给予输液250 mL/h直至分娩。比较两组初产妇的产程时长及母儿结局。
①孕妇中转剖宫产率对照组为11.89%，补液组为14.62%（P= 0.116），产后出血率为5.12%和5.48%（P= 0.747），产妇均未出现肺水肿。②阴道分娩孕妇的第一产程、第二产程及总产程时限在对照组及补液组差异无统计学意义（P= 0.935，0.288，0.829），总产程 > 12 h发生率分别为36.28%和35.16%（P= 0.690），阴道分娩者产后出血率分别为5.08%和6.26%（P= 0.349）。③两组新生儿体重、1分钟Apgar评分 ≤ 7、新生儿住院率、羊水粪染率两组差异无统计学意义（P= 0.123，1.000，1.000，0.923）。
对于产程中饮食正常的初产妇，持续静脉输液并不能改善母儿结局，可仅给予分娩镇痛后常规静脉输液。
It is supposed that intravenous fluid infusion during vaginal delivery can shorten the duration of labor and reduce cesarean delivery rate. However， there is no consensus on the routine administration of intravenous fluids in labor. Shorter duration of intravenous infusion is routinely given after epidural analgesia to prevent hypotension， and this study is aimed to evaluate the effect of continuous intravenous fluid therapy on maternal and fetal outcomes in nulliparity.
The prospective randomized controlled study was made among 1548 nulliparous pregnant women who required vaginal delivery with epidural analgesia， singleton gestation and cephalic presentation at term in our hospital from July 2020 to December 2020. Intravenous infusion was routinely given after labor analgesia， and the pregnant women could choose normal diet， the control group including 782 women received 250 mL/h for 4 hours and the fluid infusion group including 766 women received 250 mL/h to fetal delivery. The duration of labor， maternal and fetal outcomes were compared between the two groups.
The cesarean conversion delivery rate was 11.89% in the control group and 14.62% in fluid infusion group （P= 0.116）， the total postpartum hemorrhage rates were 5.12% and 5.48% （P= 0.747）， there was no pneumonedema in both groups. The length of first stage of labor， second stage of labor and the total length of labor between the two vaginal delivery groups were not statistically significant （P= 0.935，0.288，0.829）. The total lengths of labor > 12 h was respectively 36.28% and 35.16% （P= 0.690）， and the vaginal delivery postpartum hemorrhage rates were 5.08% and 6.26% （P= 0.349）. There were no significant differences in neonatal birthweight， 1-minute Apgar ≤ 7， neonatal intensive care unit admission or meconium stained amniotic fluid between the two groups （P= 0.123，1.000，1.000， 0.923）.
Continuous intravenous fluid can not improve maternal and fetal outcomes with normal diet during labor， but just provide routine duration intravenous fluid after epidural analgesia.
intravenous fluid/nulliparity/epidural analgesia/labor course/cesarean delivery
| 1 | Shrivastava VK， Garite TJ， Jenkins SM， et al. A randomized， double-blinded， controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas ［J］. Am J Obstet Gynecol， 2009， 200（4）： 379.e1. |
| 2 | Shafaie FS， Mohaddesi H， Mirghafourvand M， et al. A randomized， double-blinded，controlled trial comparing parenteral dextrose 5%， ringer′s solution and oral intake on the delivery outcomes in Nulliparas［J］. International Journal of Womens Health & Reproduction Sciences， 2017， 5（4）： 283. |
| 3 | Paré J， Pasquier JC， Lewin A， et al. Reduction of total labor length through the addition of parenteral dextrose solution in induction of labor in nulliparous： results of DEXTRONS prospective randomized controlled trial ［J］. Am J Obstet Gynecol， 2017， 216（5）： 508.e1. |
| 4 | Dawood F， Dowswell T， Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women ［J］. Cochrane Database Syst Rev， 2013（6）： CD007715. |
| 5 | 马彦彦， 庞汝彦. 正常产程中的入量管理 ［J］. 中华妇产科杂志， 2015， 50（4）： 316. |
| 6 | Practice guidelines for obstetric anesthesia： an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology ［J］. Anesthesiology， 2016， 124（2）： 270. |
| 7 | 沈晓凤， 姚尚龙. 分娩镇痛专家共识（2016版） ［J］. 临床麻醉学杂志， 2016， 32（8）： 816. |
| 8 | Hofmeyr GJ， Cyna AM， Middleton P. Prophylactic intravenous preloading for regional analgesia in labour［J］. Cochrane Database of Systematic Reviews， 2004（4）： CD000175. |
| 9 | Eslamian L， Marsoosi V， Pakneeyat Y. Increased intravenous fluid intake and the course of labor in nulliparous women ［J］. Int J Gynaecol Obstet， 2006， 93（2）： 102. |
| 10 | Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia ［J］. Am J Obstet Gynecol， 1946（52）： 191. |
| 11 | WHO. Care in normal birth： report of a technical working group ［J］. World Health Organization， 1997. |
| 12 | Committee on Obstetric Practice. Committee opinion No.687： approaches to limit intervention during labor and birth［J］. Obstet Gynecol， 2017， 129（2）： e20. |
| 13 | Garite TJ， Weeks J， Peters-Phair K， et al. A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women［J］. American Journal of Obstetrics and Gynecology， 2000， 83： 1544. |
| 14 | Edwards RK， Reed CA， Villano KS， et al. Effect of hydration on spontaneous labor outcomes in nulliparous pregnant women： a multicenter randomized controlled trial comparing three methods［J］. Am J Perinatol， 2014， 31（6）： 455. |
| 15 | Fong A， Serra AE， Caballero D， et al. A randomized， double-blinded， controlled trial of the effects of fluid rate and/or presence of dextrose in intravenous fluids on the labor course of nulliparas ［J］. American Journal of Obstetrics and Gynecology， 2017， 217（2）： 208. |
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