摘要目的:研究新产程标准下椎管内分娩镇痛产妇第二产程时长对新生儿Apgar评分及脐动脉血气指标的影响。方法:回顾新产程标准在商丘市妇幼保健院实行以来(2017年6月至2019年11月)行椎管内分娩镇痛的150例产妇的临床资料，根据第二产程时间将其分为A组(产程时间<2 h，50例)、B组(产程时间2～4 h，50例)、C组(产程时间>4 h，50例)。比较三组产妇胎儿娩出后Apgar评分、脐动脉血气指标[pH值、动脉血氧分压(PaO 2)、动脉血二氧化碳分压(PaCO 2)、缺血修饰白蛋白(IMA)]水平。 结果:B、C组Apgar评分低于A组，C组Apgar评分低于B组( P<0.05)。B、C组pH值、PaO 2水平低于A组，C组pH值、PaO 2水平低于B组( P<0.05)；B、C组PaCO 2、IMA水平高于A组( P<0.05)；C组PaCO 2、IMA水平高于B组( P<0.05)。Apgar评分、pH值、PaO 2水平与第二产程时长呈负相关( r＝-0.702、-0.767、-0.730， P<0.05)，PaCO 2、IMA水平与第二产程时长呈正相关( r＝0.741、0.750， P<0.05)。Apgar评分与pH、PaO 2水平呈正相关( r＝0.771、0.695， P<0.05)，与PaCO 2、IMA水平呈负相关( r＝-0.714、-0.728， P<0.05)。 结论:新产程标准下椎管内分娩镇痛产妇第二产程时长延长时，会导致Apgar评分下降，脐动脉血气指标中pH值、PaO 2水平下降，PaCO 2、IMA水平上升。

abstractsObjective:To study the influence of duration of the second stage of labor on neonatal Apgar score and umbilical artery blood gas indexes in puerperae with intraspinal labor analgesia under the new labor process standard.Methods:The clinical data of 150 puerperae who underwent intraspinal labor analgesia since the implementation of the new labor process standard in Shangqiu Maternal and Child Health Hospital from June 2017 to November 2019 were reviewed. And the puerperae were divided into group A (labor time<2 h, 50 cases), group B (labor time of 2-4 h, 50 cases) and group C (labor time>4 h, 50 cases) according to the duration of the second stage of labor. The Apgar score after fetal delivery and levels of umbilical artery blood gas indexes, such as pH, partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), ischemia-modified albumin (IMA), were compared among the three groups. Results:The Apgar scores in group B and group C were significantly lower than those in group A, and the Apgar score in group C was significantly lower than that in group B ( P<0.05). The pH and PaO 2 in group B and group C were significantly lower than those in group A, and the pH and PaO 2 in group C were significantly lower than those in group B ( P<0.05). The PaCO 2 and IMA in group B and group C were significantly higher than those in group A, and the PaCO 2 and IMA in group C were significantly higher than those in group B ( P<0.05). The Apgar score, pH and PaO 2 were negatively correlated with the duration of the second stage of labor ( r=-0.702, -0.767, -0.730; P<0.05); while PaCO 2 and IMA were positively correlated with the duration of the second stage of labor ( r=0.741, 0.750; P<0.05). Apgar score was positively correlated with pH and PaO 2 ( r=0.771, 0.695; P<0.05); and Apgar score was negatively correlated with PaCO 2 and IMA ( r=-0.714, -0.728; P<0.05). Conclusions:Under the new labor process standard, the prolongation of the second stage of labor of puerperae with intraspinal labor analgesia can decrease Apgar score and umbilical artery blood gas indexes, including pH and PaO 2, however, increase the levels of PaCO 2 and IMA.