宫颈扩张球囊促宫颈成熟的疗效研究

宫颈扩张球囊促宫颈成熟的疗效研究

目的研究宮颈扩张球囊促宫颈成熟的疗效。方法选取2016年6月～2017年5月在云浮市妇幼保健计划生育服务中心分娩且有引产指征的120例孕妇作为研究对象，采用随机数表法将其分为球囊组、对照组，每组60 例。球囊组宫颈扩张球囊促宫颈成熟、对照组采用缩宫素促宫颈成熟。比较两组处理后宫颈成熟情况，总产程时间，剖宫产率，新生儿情况等分娩结局。结果球囊组患者的促宫颈成熟的总有效率均显著高于对照组，差异有统计学意义（P＜0.05）；分娩过程中，球囊组患者的用药到临产时间、第一产程时间、第二产程时间、第三产程时间均短于对照组，差异有统计学意义（P＜0.05）；分娩后，球囊组的产后出血量少于对照组，差异有统计学意义（P＜0.05），宫颈裂伤率、剖宫产率均低于对照组，差异有统计学意义（P＜0.05），两组的新生儿Apgar评分比较，差异无统计学意义（P>0.05）。结论宫颈扩张球囊能促进宫颈条件不佳的宫颈成熟，取出球囊后，能顺利实施引产，提高引产成功率，对孕妇损伤小，安全有效。

[Abstract]Objective To study the curative effect of cervical dilatation balloon for cervical ripening.Methods All of 120 pregnant women who gave birth in Yunfu maternal and child health and family planning service center from June 2016 to May 2017 and had indications for induced labor were randomly divided into balloon group and control group with 60 cases in each group.Balloon group cervical dilatation balloon to promote cervical ripening，control group using oxytocin to promote cervical ripening.The cervical ripening，total labor time，cesarean section rate and neonatal conditions were compared between the two groups.Results The total effective rate of cervical ripening in balloon group was significantly higher than that in control group，and the difference was statistically significant（P＜0.05）；during the childbirth，the time from drug use to delivery，the time of the first stage of labor，the time of the second stage of labor and the time of the third stage of labor of balloon group were shorter than those of control group，and the differences were statistically significant（P＜0.05）；after childbirth，the postpartum hemorrhage volume of balloon group was less than that of control group and the difference was statistically significant（P＜0.05），the rate of cervical laceration，caesarean section were lower than those of control group，and the differences were statistically significant （P＜0.05）.There was no statistically significant in Apgar score between the two groups （P>0.05）.Conclusion The cervical dilatation balloon can promote the cervical ripening of the cervix with poor cervical conditions.After the balloon is taken out，the labor induction can be carried out successfully，and the success rate of induced labor is improved，which is safe and effective for pregnant women with small injury.[Key words]Cervical dilated balloon；Full-term pregnancy induced labor；Cervical maturation；Oxytocin

引产是通过机械性手段或药物干预来使宫颈扩张、进入临产并达到阴道分娩目的的产科干预手段，足月妊娠引产术被用于妊娠晚期合并高血压、糖尿病、羊水过少等情况的分娩[1-2]。宫颈成熟度是影响引产成功率的最重要因素，宫颈不

成熟会降低引产成功率并增加产后并发症的发生风险[3-4]。因此，对于有引产指征且宫颈不成熟的孕妇，需要给予促宫颈成熟的干预手段来保证引产的顺利进行。缩宫素是促宫颈成熟最常用的药物，但是受到个体药物敏感性的差异，缩宫素容易引起子宫过度刺激和收缩，效果并不令人满意[5-6]。宫颈球囊扩张是机械性促宫颈成熟的方式[7-8]，我们在下列研究中具体分析了宫颈扩张球囊促宫颈成熟的疗效。

1资料与方法

1.1 一般资料

選取2016年6月～2017年5月云浮市妇幼保健计划生育服务中心住院分娩且有引产指征的120例孕妇作为研究对象，采用随机数表法将其分为球囊组、对照组，每组60 例。

选择标准：孕41周后、单胎、头先露、胎膜完整、畸胎、死胎引产，无阴道分娩禁忌证、宫颈Bishop评分0.05），具有可比性。

1.2 引产方法

球囊组：宫颈扩张球囊（Cook宫颈扩张球囊：美国库克公司，规格型号J-CRB-184000）。为18Fr导管，长度40 cm，远瑞有两个球囊，分别可容纳80 ml 液体。孕妇取膀胱截石位，常规消毒外阴、阴道后行阴道后行阴道检查，高年资主治医师行宫颈Bishop成熟度评分，再次消毒阴道后用卵圆钳将双球囊沿子宫颈管侧缓慢送入宫颈内口上方羊膜腔外，待阴道球囊完全进入宫颈内后向子宫球囊内注入生理盐水40 ml，轻轻向外牵拉，使水囊紧压宫颈内口处，继而向阴道球囊内注入生理盐水20 ml，然后以20 ml/次，依次向子宫球囊及阴道球囊内注入生理盐水至总量80 ml。将导管尾部固定于孕妇大腿内侧。12 h取出球囊后再次行宫颈Bishop评分，宫颈Bishop评分≥6分者行人工破膜，观察宫缩情况，若

1 h后无规律宫缩者结合缩宫素引产。当出现以下情况之一时立即取出双球囊：

①进入活跃期，其标志为每30 min至少4次宫缩，伴宫颈消退及宫口扩张≥3 cm；

②胎膜自然破裂；③可疑胎儿窘迫；④放置>12 h。

对照组患者给予缩宫素促宫颈成熟：缩宫素2.5 U加入生理盐水500 ml中，起始剂量8滴/min、逐步加至最大剂量32滴/min。

1.3 观察指标及评价标准

干预后12 h，采用Bishop评分评估宫颈的成熟度，Bishop评分提高超过3分为显效、提高2～3分为有效、评分提高不足2分为无效。同时，观察两组患者从用药到临产的时间以及各个产程的时间，记录两组患者产后出血量及宫颈裂伤例数、剖宫产例数，分娩后采用Apgar评分评估新生儿质量。

1.4 统计学方法