【摘要】 目的：探讨不同时机椎管内分娩镇痛联合助产士主导陪伴在妊娠期糖尿病(GDM)产妇分娩中的效果。方法：选取2020年12月-2024年3月本院产科接受椎管内镇痛分娩的GDM产妇80例，根据不同时机实施椎管内分娩镇痛分为两组，分别在宫口开启≥3cm(37例，对照组)或<3cm(43例，观察组)行椎管内分娩镇痛联合助产士主导陪伴。比较两组一般临床资料、各产程时间、分娩2h后出血量、分娩后血糖水平、会阴情况及新生儿出生血糖水平、新生儿5min Apgar评分及不良反应情况。结果：观察组第一产程时间(411.65±87.56 min)短于对照组(499.74±113.56 min)(P<0.05),第二、第三产程时间两组无差异(P>0.05)。观察组分娩后血糖水平(6.48±0.88 mmol/L)低于对照组(7.23±1.64 mmol/L)(P<0.05)。两组分娩2h后出血量、会阴情况以及新生儿出生血糖水平和出生5min Apgar评分均无差异(P>0.05)。观察组不良反应发生率(11.6%)低于对照组(32.4%)(P<0.05)。结论：在宫口开启<3cm时行椎管内分娩镇痛联合助产士主导陪伴相比于宫口开启≥3cm时效果更好，可缩短第一产程时长，且对分娩后出血量、GDM产妇及新生儿血糖水平无影响。更多还原

【Abstract】 Objective:To explore the effect of the neuraxial labor analgesia at different times combined with the midwife-led accompaniment during delivery of pregnant women with gestational diabetes mellitus(GDM).Methods:80 pregnant women with GDM who wanted delivered with the neuraxial delivery analgesia in the obstetric department of the hospital from December 2020 to March 2024 were selected and were divided into two groups according to the different timing of the neuraxial delivery analgesia,37 women with the neuraxial delivery analgesia at their cervical opening ≥3cm were in group A and 43 women with the neuraxial delivery analgesia combined with midwife-led companionship at their cervical opening <3cm were in group B.The general clinical data,the time of labor,the bleeding amount in 2h after delivery,the blood glucose level after delivery,the perineal status,the neonatal Apgar score in at 5minafter birth and the adverse reactions rate of the women were compared between the two groups.Results:The duration of the first stage of labor(411.65±87.56 min) of the women in group B was significantly shorter than that(499.74±113.56 min)of the women in group A(P<0.05).There were no significant differences in the durations of the second and the third stages of labor of the women between the two groups(P>0.05).The blood glucose level(6.48±0.88 mmol/L) of the women in group B after delivery was significantly lower than that(7.23±1.64 mmol/L) of the women in group A(P<0.05).There were no significant differences in the blood loss at 2 hours after delivery,the perineal condition,and the neonatal blood glucose level at birth and the neonates Apgar score at 5 minutes after birth of the women between the two groups(P>0.05),The adverse reactions incidence(11.6%) of the women in group B was significantly lower than that(32.4%) of the women in group A(P<0.05).Conclusion:The labor analgesia effect of the women with the intravertebral labor analgesia combined with midwife-led accompaniment at their cervical opening <3cm is better than that of the women with the intravertebral labor analgesia at their cervical opening≥3cm,and which can shorten the duration of the first stage of labor,and has no any effect on the amount of blood loss of the women after delivery and on the maternal and the neonatal blood glucose levels after delivery.更多还原