引用本文:蒋 晖.椎管内低剂量药物镇痛对基因型A118G-AA型的剖宫产再孕孕妇足月妊娠经阴道分娩的临床探讨[J].中国临床新医学,2020,13(2):165-168.
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椎管内低剂量药物镇痛对基因型A118G-AA型的剖宫产再孕孕妇足月妊娠经阴道分娩的临床探讨
蒋 晖
541002 广西,桂林市人民医院妇产科
摘要:
[摘要] 目的 探讨椎管内低剂量药物镇痛对基因型A118G-AA型且剖宫产再孕孕妇足月妊娠经阴道分娩的可行性及安全性。方法 选取剖宫产再孕且妊娠37周后在该院自愿要求阴道分娩孕妇200例,产科门诊评估其有阴道试产条件且自愿要求抽其静脉血检测基因型A118G-AA型,外送贝瑞基因应用PCR-RFLP法。根据OPRM1外显子1第118位点处的碱基情况判定孕妇基因型,选取AA型(野生型)共62例临产后均进入阴道试产,根据镇痛方式不同分为观察组(n=30)和对照组(n=32)。观察组采用椎管内低剂量药物镇痛。对照组采用导乐仪镇痛。对比分析两组的产程、阴道分娩成功率、分娩结局及产后满意度。结果 观察组分娩成功率为86.7%,高于对照组的59.4%(P<0.05)。观察组孕妇在第一产程时间、会阴裂伤程度、视觉模拟疼痛评分、产后满意度调查和泌乳始动时间方面均优于对照组(P<0.05)。结论 对A118G-AA型剖宫产再孕足月妊娠孕妇阴道分娩应用低剂量药物椎管内镇痛安全有效,镇痛效果优于导乐仪镇痛。
关键词:  剖宫产再孕  椎管内镇痛  导乐仪镇痛  阴道分娩  低剂量药物镇痛
DOI:10.3969/j.issn.1674-3806.2020.02.15
分类号:R 714
基金项目:
Clinical study of intraspinal analgesia with low-dose drugs on full-term vaginal delivery in re-pregnant women with genotype A118G-AA and previous cesarean section
JIANG Hui
Department of Obstetrics and Gynecology, Guilin People′s Hospital, Guangxi 541002, China
Abstract:
[Abstract] Objective To investigate the feasibility and safety of intraspinal analgesia with low-dose drugs for full-term vaginal delivery in re-pregnant women with genotype A118G-AA and previous cesarean section. Methods Two hundred cases of re-pregnant women with previous cesarean section who voluntarily requested vaginal delivery in our hospital after 37 weeks of pregnancy were selected. According to the evaluation of the Outpatient Department of Obstetrics of our hospital, these 200 women had vaginal trial delivery conditions and voluntarily asked to take their venous blood sent to Berry Genomics for detecting genotype A118G-AA by polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP) Assay. The genotypes of the pregnant women were determined according to the base of OPRM1 exon 1 at site 118. A total of 62 cases of genotype AA(wild type) were selected for vaginal trial delivery. They were divided into the observation group(n=30) and the control group(n=32) according to different analgesic methods. The observation group was treated with low-dose intraspinal analgesia and the control group was given Doula instrument analgesia(music-guide analgesic instrument). The course of labor, the success rate of vaginal delivery, the delivery outcome and the maternal satisfaction after birth were analyzed and compared between the two groups. Results The success rate of vaginal delivery in the observation group(86.7%) was significantly higher than that in the control group(59.4%)(P<0.05). The observation group was superior to the control group in terms of the first stage of labor, the perineal laceration degree, the Visual Analogue Scale score, the maternal satisfaction after birth and lactation initiation time(P<0.05). Conclusion Intraspinal analgesia with low-dose drugs is safe and effective for full-term vaginal delivery in re-pregnant women with genotype A118G-AA and previous cesarean section. The analgesic effect of intraspinal analgesia with low-dose drugs is better than that of Doula instrument analgesia.
Key words:  Repregnancy after cesarean section  Intraspinal analgesia  Doula instrument analgesia  Vaginal delivery  Low-dose drug analgesia