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目的分析硬膜外给药分娩镇痛中,因多种因素导致产程进展困难,改行剖宫产术中宫缩乏力的原因,探索治疗方法。方法选择自愿接受硬膜外给药分娩镇痛术的孕足月初产妇48例,年龄22～36岁,体重62～85kg,孕期38～41周、临产。在分娩镇痛术中产程进展不顺利,改行剖宫产术,出现宫缩乏力。在其治疗过程中随机分为两组:Ⅰ组单纯静脉注射缩宫素治疗,Ⅱ组在静脉注射缩宫素的同时,静脉缓慢注射10%葡萄糖酸钙10～20ml。结果Ⅱ组患者宫缩恢复快而强,缩宫素用量小:Ⅰ组宫缩恢复时缩宫素用量大,而且需要应用其他子宫收缩药。结论椎管内硬膜外给药分娩镇痛术后改行剖宫产术.术中发生宫缩乏力的原因与局麻药的长久作用及孕足月产妇血清钙降低有关。治疗宫缩乏力,静脉注射宫缩素加10%葡萄糖缓慢静脉注射的作用优越于单纯静脉注射缩宫素治疗方法。
Objective To analyze the causes of uterine atony during cesarean section due to various factors that lead to difficulties in the progress of labor, and to explore the treatment methods. Methods Forty-eight pregnant women, aged 22-36 years, weighing 62-85 kg, were enrolled in the first trimester of pregnancy. The labor was 38-41 weeks of pregnancy. In labor analgesia during labor progress is not smooth, change cesarean section, uterine inertia. In the course of their treatment, they were randomly divided into two groups: Group Ⅰ was treated with oxytocin only; Group Ⅱ was injected with oxytocin 10-15% while intravenous injection of 10-20% calcium gluconate was injected slowly. Results In group Ⅱ, the uterine contraction was fast and strong, and the dosage of oxytocin was small: the amount of oxytocin in uterine contractions in group Ⅰ was large, and other uterine contractions were needed. CONCLUSIONS: Intra-spinal epidural delivery of labor analgesia is followed by cesarean section, and the causes of uterine atony in the spinal canal are related to the long-term effects of local anesthetics and serum calcium in preterm pregnant women. Treatment of uterine inertia, intravenous orifin plus 10% glucose intravenous injection is superior to the simple intravenous oxytocin treatment.