硬膜外分娩镇痛对初产妇第二产程用力时机的研究  

Epidural analgesia and the timing of use of force byprimipara during the second stage of labor

作　　者：邵慧静[1] 李一美[1] 林晓秋[1] 

机构地区：[1]温州医科大学附属第二医院产科,浙江温州325000

出　　处：《健康研究》2017年第4期376-378,382,共4页Health Research

基　　金：温州市科技计划项目(Y20140626)

摘　　要：目的探讨指导硬膜外镇痛初产妇采取不同时机用力对母婴结局的影响,以规范对硬膜外镇痛产妇第二产程的科学管理。方法行硬膜外镇痛分娩的初产妇200例随机分为立即用力组(immediate pushing,IP组)和延迟用力组(delayed pushing,DP组);IP组产妇在宫口开全后按常规立即指导用力,DP组产妇在宫口开全1小时后开始指导用力,比较两组的母婴结局。结果 IP组产妇自然分娩率和产后满意度均低于DP组,但IP组产钳助娩率、第二产程时间、用力屏气时间、产后出血量、产后疲乏程度、产后尿潴留发生率均高于DP组,差异均具有统计学意义(P<0.05)。2组产妇剖宫产率、第一产程时间、会阴损伤率、胎心减速比例、胎儿出生1min时Apgar评分>7的比例、脐动脉血PH值均无统计学差异(P>0.05)。结论硬膜外镇痛初产妇采取延迟用力可缩短第二产程时间,增加阴道分娩率,减轻产妇的疲乏程度和产后尿潴留发生率,增加产后满意度,且对新生儿无明显影响。ObjectiveTo understand the effects ofepidural analgesia and different timing for use of force by the primipara on the pregnancy outcome so as to formulate more scientific management for epidural analgesia during the second stage of labor. Method 200 cases of primipara for epidural analgesia were randomly divided into immediate pushing group （ IP group） and delayed pushing group （DP group）. The IP group were instructed to use routine pushing rightafter the cervical canal was fully opened while the DP group were instructed to use pushingl hour after the cervical canal was fully opened.The maternal and neonatal outcomes between the two groups were compared. Findings The rate of natural delivery and postpartum satisfaction in thelP group were lower than those in the DP group. However,the rate of forceps delivery, the second stage of labor time, spurts time, postpartum hemorrhage, postpartum fatigue, postpartum urinary retention rate in the IP groupwere higher than those in the DP group. The differences were statistically significant （P〈 0.05 ）. No significant differenceswere found between the two groups in maternal cesarean section, the first stage of labor time, perineal injury rate, fetal heart rate of deceleration, Apgar score 〉 7 ratio atlminafter the birth and the umbilical artery blood pH （P〉0.05）. Conclusion Epidural analgesia for primipara applied along with delayed pushing can shorten the length of time for the second stage of labor, increase the rate of vaginal deliveryand postpartum satisfaction, reduce maternal postpartum fatigue and the incidence of urinary retention and impose no significant side effect on the newborn.

关 键 词：硬膜外镇痛 第二产程 延迟用力 母婴结局 

分 类 号：R71[医药卫生—妇产科学]