本文選題：雙球囊導(dǎo)管　切入點(diǎn)：足月妊娠　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的:了解雙球囊導(dǎo)管用于足月妊娠促宮頸成熟及引產(chǎn)的有效性、安全性和對產(chǎn)程的影響。 方法:回顧性分析2012年7月～2013年5月在中國人民解放軍第210醫(yī)院住院分娩的初產(chǎn)婦594例，其中以雙球囊導(dǎo)管促宮頸成熟及引產(chǎn)的產(chǎn)婦106例（DBC組），以控釋地諾前列酮栓促宮頸成熟及引產(chǎn)的產(chǎn)婦104例（CRD組），自然臨產(chǎn)并陰道分娩的產(chǎn)婦384例（對照組）；收集試驗對象的宮頸評分變化、分娩方式、引產(chǎn)至臨產(chǎn)時間、產(chǎn)程進(jìn)展以及產(chǎn)后觀察各項指標(biāo)；采用獨(dú)立樣本t檢驗、單因素方差分析以及χ2檢驗，對上述指標(biāo)進(jìn)行統(tǒng)計學(xué)分析，并用Excel散點(diǎn)圖擬合各種產(chǎn)程曲線，對雙球囊導(dǎo)管促宮頸成熟及引產(chǎn)的有效性、安全性和對產(chǎn)程的影響進(jìn)行分析評價，從而為產(chǎn)科臨床提供良好的治療方法。 結(jié)果： 一、雙球囊導(dǎo)管促宮頸成熟及引產(chǎn)的有效性：1、宮頸評分：DBC組產(chǎn)婦放置雙球囊導(dǎo)管前、后宮頸Bishop評分差異顯著（p＜0.05）；DBC組產(chǎn)婦從放置至取出球囊宮頸Bishop評分平均提高2.70分，但與CRD組(均數(shù)2.72分)比較，差異不顯著（p＞0.05）；2、分娩方式：DBC組和CRD組產(chǎn)婦分娩方式構(gòu)成比差異顯著（p＜0.05），DBC組產(chǎn)婦剖宮產(chǎn)率低于CRD組；3、改行剖宮產(chǎn)指征：產(chǎn)婦改行剖宮產(chǎn)指征按由高到低順序，DBC組依次為：產(chǎn)程異常、社會因素、胎兒窘迫、引產(chǎn)失��；CRD組依次為：胎兒窘迫、產(chǎn)程異常、社會因素、引產(chǎn)失敗,兩組剖宮產(chǎn)指征構(gòu)成比差異顯著（p＜0.05），其中DBC組產(chǎn)婦以引產(chǎn)失敗和胎兒窘迫為指征而改行剖宮產(chǎn)分娩的比例低于CRD組。 二、雙球囊導(dǎo)管促宮頸成熟及引產(chǎn)的安全性： CRD組經(jīng)陰道分娩產(chǎn)婦產(chǎn)程中子宮強(qiáng)直收縮發(fā)生率為1.61%，其余兩組均無子宮強(qiáng)直收縮病例發(fā)生；三組經(jīng)陰道分娩產(chǎn)婦產(chǎn)后2小時出血量及產(chǎn)后尿潴留發(fā)生率比較，差異均不顯著（p＞0.05）；三組陰道分娩的新生兒均無新生兒窒息病例發(fā)生。 三、雙球囊導(dǎo)管促宮頸成熟及引產(chǎn)對產(chǎn)程的影響：DBC組與對照組產(chǎn)婦比較，DBC組第一產(chǎn)程及總產(chǎn)程顯著縮短（p＜0.05），第二、三產(chǎn)程與對照組比較無明顯差異（p＞0.05），進(jìn)一步分析表明，DBC組產(chǎn)婦第一產(chǎn)程的潛伏期較對照組顯著縮短（p＜0.05），，而活躍期與對照組無明顯差異（p＞0.05）；DBC組與CRD組產(chǎn)婦比較，第一、二、三產(chǎn)程及總產(chǎn)程均無顯著差異（p＞0.05），進(jìn)一步分析表明DBC組產(chǎn)婦第一產(chǎn)程的潛伏期較CRD組顯著縮短（p＜0.05），活躍期長于CRD組（p＜0.05）。 結(jié)論：雙球囊導(dǎo)管用于足月妊娠促宮頸成熟及引產(chǎn)具有良好的臨床效果，可顯著改善宮頸條件，無藥物引產(chǎn)的副作用，使用安全性較高，并可縮短產(chǎn)程，從而減輕了產(chǎn)婦對產(chǎn)痛的焦慮及體力消耗。因此，具有較好的臨床推廣應(yīng)用價值。
[Abstract]:Objective: to investigate the efficacy, safety and effect of double balloon catheter on cervical maturation and labor induction in term pregnancy.Methods: from July 2012 to May 2013, 594 cases of primiparous delivery in the 210th Hospital of the Chinese people's Liberation Army were retrospectively analyzed.Among them, 106 cases were treated with double-balloon catheter to promote cervical maturation and induced labor, 104 cases were treated with controlled-release diloprostone suppository to promote cervical maturation and induced labor, 384 cases of spontaneous labor and vaginal delivery were collected (control group;The cervical score of the subjects,The methods of delivery, the time of induced labor to labor, the progress of labor and the indexes of postpartum observation were analyzed statistically by using independent sample t test, single factor analysis of variance and 蠂 2 test.All kinds of labor process curves were fitted with Excel scatter plot to analyze and evaluate the efficacy, safety and effect of double balloon catheter on cervix maturation and labor induction, so as to provide a good treatment method for obstetrical clinic.Results:The results were as follows: 1. The effectiveness of double balloon catheter in promoting cervical maturation and inducing labor was 1: 1. The cervical Bishop score increased by 2.70 points on average from the time of placement to the removal of balloon cervix, and the difference of cervical Bishop score between the two groups was significant (p < 0.05) before the placement of the double balloon catheter.But compared with the CRD group (mean 2.72),There was no significant difference (p > 0.05). There was a significant difference in the proportion of delivery mode composition between the two groups (P < 0.05). The rate of cesarean section in the CRD group was lower than that in the CRD group (P < 0.05), and the indication of cesarean section: the indication of cesarean section was abnormal in the order of high to low order.The social factors, fetal distress, induced labor failure and CRD group were fetal distress, abnormal labor process, social factors and induced labor failure.The ratio of indications of cesarean section was significantly different between the two groups (p < 0.05). In DBC group, the rate of cesarean section delivery was lower than that in CRD group, which was indicated by induced abortion and fetal distress.2. The safety of double balloon catheter in promoting cervix maturation and induced labor: the incidence of uterine ankylosis contraction in CRD group was 1.61g during the parturition, and there were no cases of uterine ankylosis contraction in the other two groups.There was no significant difference in the rate of postpartum blood loss and postpartum urinary retention among the three groups, and there was no neonatal asphyxia in the three groups.The effect of double balloon catheter on the labor process of cervix maturation and induction of labor the first stage and total stage of labor in the DBC group were significantly shorter than those in the control group (P < 0.05), and the second, the first stage of labor and the total stage of labor in the DBC group were significantly shorter than those in the control group (P < 0.05).There was no significant difference between the three stages of labor and the control group (p > 0.05). Further analysis showed that the latency of the first stage of labor in the DBC group was significantly shorter than that in the control group (p < 0.05), but there was no significant difference between the active period and the control group (p > 0.05).There was no significant difference between the three stages of labor and the total stage of labor (p > 0.05). Further analysis showed that the latency of the first stage of labor in the DBC group was significantly shorter than that in the CRD group (P < 0.05), and the active period was longer than that in the CRD group (p < 0.05).Conclusion: double balloon catheter has a good clinical effect in promoting cervical maturation and induced labor in term pregnancy. It can significantly improve the cervical condition, have no side effect of drug induced labor, be used safely, and shorten the labor process.As a result, the parturient's anxiety about labor pain and physical exertion were alleviated.Therefore, it has good clinical application value.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R719.3

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