硬膜外镇痛分娩在瘢痕子宫产妇中的应用  

THE APPLICATION OF EPIDURAL DELIVERY ANALGESIA IN PUERPERA WITH SCAR UTERINE

作　　者：宋丽[1] 施森[2] 莫利群[1] 冯光连[3] 

机构地区：[1]泸州医学院附属医院麻醉科,四川省泸州市646000 [2]泸州医学院附属医院血管外科,四川省泸州市646000 [3]泸州医学院附属医院妇产科,四川省泸州市646000

出　　处：《中国煤炭工业医学杂志》2016年第1期32-35,共4页Chinese Journal of Coal Industry Medicine

摘　　要：目的评估硬膜外镇痛分娩用于瘢痕子宫产妇阴道分娩的安全性。方法选取阴道分娩的瘢痕子宫产妇100例,观察组(50例)自愿要求硬膜外镇痛,对照组(50例)未采用任何镇痛方法,观察镇痛效果、产程各阶段时间、缩宫素使用情况、分娩方式、子宫有无破裂、产后出血量和新生儿第1、5min时Apgar评分。结果随产程进展,对照组疼痛评分明显升高,而观察组实施硬膜外镇痛后疼痛评分明显降低,差异有统计学意义(P<0.01)。与对照组相比,观察组转剖宫产率降低,差异有统计学意义(P<0.05),虽然观察组缩宫素使用率和使用量增加,第二产程时间延长,但无一例发生子宫破裂,产钳助产率、产后出血量及新生儿第1、5min时Apgar评分差异无统计学意义(P>0.05)。结论瘢痕子宫产妇硬膜外镇痛分娩不增加母儿并发症,且能避免因疼痛致信心不足而中转剖宫产,提高阴道分娩成功率,值得临床推广。Objective To evaluate the safety of epidural delivery analgesia in the vaginal delivery of puerpera with scar uterine.Methods One hundred puerpera patients with scar uterine who will perform vaginal delivery were taken in this research.Observation group（n=50）voluntarily request epidural delivery analgesia,another 50 without any analgesia were in control group.The effect of analgesia,the time of every labor stage,the use of Oxytocin,the mode of delivery,presence of uterine rupture,postpartum hemorrhage and the natural Apgar score in the first and fifth minute were observed respectively.Results With the progress of labor,the pain score was significantly higher in the control group,while the pain score was significantly lower in the observation group after epidural,there was statistically significant between the two groups（P〈0.01）.Compared with the control group,the cesarean section rate was decreased in the observation group,there was statistical significance between them（P〈0.05）.Although the use rate and usage of Oxytocin was increased in observation group,and the second stage of labor time prolonged,but no uterine rupture happened,there were no statistically significant in forceps delivery rate,postpartum hemorrhage and newborn Apgar scores in the first 1 and 5 min（P〉0.05）.Conclusion Epidural delivery analgesia in puerpera with scar uterine during labor does not increase the complications of mothers and infants,and can avoid transfer to cesarean section which caused by the pain or lack of confidence,and it can improve the success rate of vaginal delivery and worth the clinical promotion.

关 键 词：硬膜外镇痛分娩 瘢痕子宫 阴道分娩 子宫破裂 

分 类 号：R714.22[医药卫生—妇产科学]