目的探讨硬膜外自控镇痛(PCEA)在自然分娩过程中的镇痛效果及对孕妇产程、血液中缩宫素水平和新生儿的影响。方法选择2018年6月-2019年1月在我院产科要求自然分娩的符合要求的孕妇,根据分娩过程中是否镇痛分为观察组(行PCEA)和对照组(未行PCEA)。分别于宫口开大于3 cm时(T1)、T1后60 min时(T2)采集孕妇肘静脉血,检测血浆中缩宫素水平,计算两个时间点缩宫素浓度的差值;同时记录两组孕妇T2时的疼痛视觉模拟评分(VAS评分)、第一与二产程时间、新生儿1 min和5 min Apgar评分。结果两组孕妇血液中缩宫素水平差值比较,差异有显著性(t=11.34,P<0.01);观察组第一、二产程时间长于对照组,差异均有统计学意义(t=6.69,7.44,P<0.05);T2时,两组孕妇VAS评分差异显著性(t=10.57,P<0.01);两组新生儿出生后1 min和5 min Apgar评分差异无统计学意义(P>0.05)。结论PCEA在自然分娩中的镇痛效果显著,对新生儿无不良影响,PCEA可能抑制孕妇血液中缩宫素的分泌并使第一、二产程延长。
妊娠期糖尿病(gestational diabetes mellitus, GDM)是在妊娠期发生或首次发现的不同程度的糖耐量异常,是一种葡萄糖利用障碍性疾病。在我国,使用世卫组织标准,GDM的流行率为5%~9%;使用我国最新诊断标准,GDM的发病率约为18%~20%。近年来,GDM的发病率不断升高,对母儿健康造成了巨大影响。目前对GDM的发病机制尚无定论,可能与胰岛素抵抗和β细胞功能障碍有关。此外,也有研究表明,免疫因素、肠道菌群紊乱、炎症反应、脂肪因子等与GDM的发生存在相关性,但多为回顾性研究,相关证据并不充分。遗传因素、肥胖、多囊卵巢综合征病史、不良孕产史等也是GDM的危险因素。本文主要对妊娠期糖尿病的危险因素和发病机制作出总结,从而进一步对妊娠期糖尿病的发病机制、管理和治疗寻找新的思路。Gestational diabetes mellitus (GDM) is an abnormal glucose tolerance of varying degrees that occurs or is first detected during pregnancy and is a disorder of glucose utilization. In our country, using WHO standards, the prevalence of GDM is 5%~9%;Using the latest diagnostic criteria in China, the incidence of GDM is about 18%~20%. In recent years, the incidence of GDM has been increasing, which has caused great impact on the health of mother and child. At present, the pathogenesis of GDM is still inconclusive, which may be related to insulin resistance and β cell dysfunction. In addition, studies have also shown that immune factors, intestinal flora disorders, inflammatory responses, and adipokines are correlated with the occurrence of GDM, but most of them are retrospective studies and the relevant evidence is insufficient. Genetic factors, obesity, history of polycystic ovary syndrome, and adverse pregnancy history are also risk factors for GDM. This article mainly summarizes the risk factors and pathogenesis of gestational diabetes, so as to further find new ideas for the pathogenesis, management and treatment of gestational
