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

摘要/Abstract

摘要： 目的

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。

方法

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。

结果

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）。

结论

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。

关键词: 静脉输液, 初产妇, 分娩镇痛, 产程, 剖宫产

Abstract: Objective

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.

Methods

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.

Results

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）.

Conclusion

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.

Key words: intravenous fluid, nulliparity, epidural analgesia, labor course, cesarean delivery

中图分类号:

R714.3

沙晓燕, 吴雪, 郑峥, 张慧珠, 赖毓冕. 产程中持续静脉输液对初产妇母儿结局的影响[J]. betway必威登陆网址（betway.com ）学报, 2021, 42(7): 504-507.

Xiaoyan Sha, Xue Wu, Zheng Zheng, Huizhu Zhang, Yumian Lai. Effect of continuous intravenous fluid during labor on maternal and fetal outcomes of nulliparity[J]. Journal of Shandong First Medical Unversity & Shandong Academy of Medical Sciences, 2021, 42(7): 504-507.

图/表 4

参考文献 15

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组别	年龄（岁）	分娩孕周（周）	BMI（kg/m²）	妊娠合并症（%）	输液时宫口（cm）
对照组（n = 782）	29.31 ± 3.83	39.59 ± 0.92	25.22 ± 2.82	195（24.94）	2.24 ± 0.96
补液组（n = 766）	29.11 ± 3.28	39.52 ± 0.88	25.23 ± 2.91	195（25.46）	2.20 ± 0.91
t/χ²	1.138	1.474	0.034	0.056	0.810
P	0.255	0.141	0.973	0.813	0.418

组别	年龄（岁）	分娩孕周（周）	BMI（kg/m²）	妊娠合并症（%）	输液时宫口（cm）
对照组（n = 782）	29.31 ± 3.83	39.59 ± 0.92	25.22 ± 2.82	195（24.94）	2.24 ± 0.96
补液组（n = 766）	29.11 ± 3.28	39.52 ± 0.88	25.23 ± 2.91	195（25.46）	2.20 ± 0.91
t/χ²	1.138	1.474	0.034	0.056	0.810
P	0.255	0.141	0.973	0.813	0.418

组别	顺产	钳产	中转剖宫产	产后出血	心衰/肺水肿
对照组（n = 782）	655（83.76）	34（4.35）	93（11.89）	40（5.12）	0
补液组（n = 766）	623（81.33）	31（4.05）	112（14.62）	42（5.48）	0
χ²	1.584	0.087	2.508	0.104
P	0.228	0.801	0.116	0.747

组别	顺产	钳产	中转剖宫产	产后出血	心衰/肺水肿
对照组（n = 782）	655（83.76）	34（4.35）	93（11.89）	40（5.12）	0
补液组（n = 766）	623（81.33）	31（4.05）	112（14.62）	42（5.48）	0
χ²	1.584	0.087	2.508	0.104
P	0.228	0.801	0.116	0.747

组别	第一产程（min）	第二产程（min）	总产程（min）	产程 > 12 h［n（%）］	产后出血［n（%）］
对照组（n = 689）	591.43 ± 228.15	52.85 ± 30.90	648.46 ± 235.37	250（36.28）	35（5.08）
补液组（n = 655）	590.37 ± 248.14	51.05 ± 31.24	645.56 ± 256.90	230（35.16）	41（6.26）
t/χ²	0.81	1.064	0.216	0.182	0.876
P	0.935	0.288	0.829	0.690	0.349