连续蛛网膜下腔阻滞在剖宫产再孕经阴道试产分娩镇痛中的可行性研究  

Feasibility of continuous subarachnoid block in analgesia for trial of labor after cesarean

作　　者：王一男[1] 徐铭军[1] 陈永杰 Wang Yinan;Xu Mingjun;Chen Yongjie(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Central Laboratory,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,100026 [2]首都医科大学附属北京妇产医院中心实验室,100026

出　　处：《中国医药》2020年第3期439-443,共5页China Medicine

基　　金：国家自然科学基金(31701014);北京市卫生和计划生育委员会科研项目(2018-TG-21)。

摘　　要：目的探究连续蛛网膜下腔阻滞(CSA)在剖宫产再孕经阴道试产(TOLAC)分娩镇痛中的可行性及效果。方法选取2017年6月至2019年6月首都医科大学附属北京妇产医院收治的TOLAC产妇196例,采取随机数字表法分为CSA组与连续硬膜外阻滞(CEA)组,每组98例。对比2组产妇分娩方式、分娩结局及产后满意度。结果与CEA组相比,CSA组中顺产率较高[81.6%(80/98)比61.2%(60/98)],产钳使用率及剖宫产率较低[11.2%(11/98)比22.4%(22/98)、7.1%(7/98)比16.3%(16/98)],第一产程时间较短[(419±14)min比(986±17)min],缩宫素使用率较低[30.6%(30/98)比53.1%(52/98)],差异均有统计学意义(均P<0.05)。CSA组镇痛后5及10 min时的疼痛视觉模拟量表评分均明显低于CEA组[(2.7±0.7)分比(7.7±2.0)分、(2.3±0.4)分比(5.7±1.9)分],差异均有统计学意义(均P<0.01)。2组并发症如恶心呕吐、瘙痒(轻度)、硬脊膜穿刺后头痛、产时发热发生率比较,差异均无统计学意义(均P>0.05)。CSA组有6例中转剖宫产,CEA组出现11例中转剖宫产。CSA组产后满意度高于CEA组[91.8%(90/98)比87.8%(86/98)],差异有统计学意义(χ^2=5.765,P<0.05)。结论CSA相比于CEA应用于TOLAC分娩镇痛中能够获得较为明显的效果。Objective To investigate the feasibility and efficacy of continuous subarachnoid block(CSA)in analgesia for trial of labor after cesarean(TOLAC).Methods A total of 196 pregnant women undergoing TOLAC in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from June 2017 to June 2019 were randomly divided into CSA group and continuous epidural block(CEA)group,with 98 cases in each group.Delivery mode,outcomes and postpartum satisfaction were analyzed.Results Compared with the CEA group,the CSA group had higher spontaneous labor rate[81.6%(80/98)vs 61.2%(60/98)],lower obstetric force use and cesarean rates[11.2%(11/98)vs 22.4%(22/98),7.1%(7/98)vs 16.3%(16/98)],shorter first stage of labor[(419±14)min vs(986±17)min]and lower oxytocin use rate[30.6%(30/98)vs 53.1%(52/98)](all P<0.05).Visual Analogue Scale score for pain at 5 and 10 min after analgesia in the CSA group were lower than those in the CEA group[(2.7±0.7)vs(7.7±2.0),(2.3±0.4)vs(5.7±1.9)](both P<0.01).There were no significant differences in complications including nausea and vomiting,pruritus(mild),post-dural puncture headache and parturient fever between groups(all P>0.05).There were respectively 6 and 11 cases of cesarean section in the CSA group and CEA group.Postpartum satisfaction rate in the CSA group was higher than that in the CEA group[91.8%(90/98)vs 87.8%(86/98)](χ^2=5.765,P<0.05).Conclusion CSA shows better analgesic effect on TOLAC than CEA.

关 键 词：分娩镇痛 连续蛛网膜下腔阻滞 阴道试产 剖宫产 连续硬膜外腔阻滞 

分 类 号：R714.3[医药卫生—妇产科学]