双管硬膜外分段注射利多卡因镇痛对活跃期停滞枕后位或枕横位产妇的分娩结局及母儿并发症的影响  

Effects of double-catheter epidural analgesia by lidocaine injection respectively on the delivery outcomes and maternal-infant complications for persistent posterior or lateral occipital position of protracted active phase

作　　者：李井柱[1] 王玲[1] 李晓征[2] 于文刚[2] 亢林萍[3] 刘玉秋[1] 纪向虹[3] 吴晓峰[3] 王明山[1] 陶红[3] Li Jingzhu;Wang Ling;Li Xiaozheng;Yu Wengang;Kang Linping;Liu Yuqiu;Ji Xianghong;Wu Xiaofeng;Wang Mingshan;Tao Hong(Department of Anesthesiology,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Anesthesiology,Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Obstetrics,Qingdao Municipal Hospital,Qingdao 266071,China)

机构地区：[1]青岛市市立医院麻醉科,266071 [2]青岛大学附属医院麻醉科,266000 [3]青岛市市立医院产科,266071

出　　处：《中华妇产科杂志》2020年第7期457-464,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：青岛市卫生和计划生育委员会医药科研指导计划(2015-WJZD009);青岛市市立医院临床诊疗技术创新基金(CXJJ-014)。

摘　　要：目的评价双管硬膜外分段注射利多卡因镇痛对活跃期停滞枕后位或枕横位产妇的分娩结局及母儿并发症的影响。方法选择2015年1月—2019年10月青岛市市立医院阴道试产的单胎、足月、头位的初产妇,孕周为37~42周,年龄为22~35岁,在活跃期(新产程标准:宫口开大≥6 cm)充分试产,≥2 h胎头下降延缓或停滞,经阴道检查及超声检查诊断为枕后位或枕横位。共有216例孕妇符合上述标准纳入本研究,采用前瞻性研究方法,随机数字法将其分为两组,即双管硬膜外阻滞组108例、单管硬膜外阻滞组108例,硬膜外阻滞均使用1%利多卡因进行分娩镇痛,由高年资助产士或产科医师执行新产程标准,在超声引导下指导产妇进行体位管理并适时向上推动或旋转胎头等。比较两组产妇的一般情况、非药物镇痛措施的使用情况、阴道分娩产妇的镇痛相关情况及疼痛评分、分娩相关指标、剖宫产术指征、麻醉相关指标及母儿并发症。结果(1)一般情况:两组产妇的年龄、体重、身高、孕周、持续性枕横位与枕后位的比例、头盆评分、新生儿出生体重分别比较,差异均无统计学意义(P>0.05)。(2)非药物镇痛措施的使用情况:两组产妇的拉玛泽呼吸法、导乐分娩陪伴、经皮穴位电刺激、其他措施分别比较,差异均无统计学意义(P>0.05)。(3)阴道分娩产妇的镇痛相关情况及疼痛评分:与单管硬膜外阻滞组(40例)比较,双管硬膜外阻滞组(59例)产妇的第二产程时间显著缩短[(124±44)、(86±33)min,P<0.01],镇痛30 min后[(4.4±0.5)、(0.9±0.5)分]、第二产程用力分娩时[(5.7±0.6)、(1.3±0.4)分]的疼痛视觉模拟评分显著降低(P<0.01)。(4)分娩相关指标:与单管硬膜外阻滞组比较,双管硬膜外阻滞组产妇的自然分娩率(21.3%、49.1%)、分娩体验满意率(51.9%、98.1%)显著升高(P<0.01),剖宫产率(63.0%、45.4%)、阴道手术助产率(15.7%、5.6%)显著降低(Objective To evaluate the effect of dual-tube epidural segmental injection of lidocaine analgesia on the delivery outcome and maternal and infant complications of persistent posterior occipital position postpartum or lateral occipital position postpartum patients with protracted active phase.Methods The full and single-term primiparas(n=216,37 to 42 weeks gestation,22 to 35 years)diagnosed as persistent posterior or lateral occipital position during the active period were selected from the Department of Obstetrics of Qingdao Municipal Hospital from January 2015 to October 2019.The subjects were randomly assigned into two groups:double-tube epidural block group(n=108)and single-tube epidural block group(n=108),1%lidocaine was used for epidural analgesia respectively under ultrasound guidance.Senior midwife or obstetricians implement new partogram,and guide women to perform position management,and push or rotate the fetal head in a timely manner.Observation indicators:general condition,the use of non-pharmacological analgesic measures,analgesia related conditions and pain visual analogue scale(VAS)score,delivery-related indicator,cesarean section indication,anesthesia-related indicator,maternal and child complications.Results(1)General condition:the age,weight,height,gestational age,the ratio of persistent lateral or posterior occipital position,cephalic score,and neonatal birth weight between the two groups of women were not statistically significant(all P>0.05).(2)The use of non-pharmacological analgesic measures:the women’s Lamaze breathing method,Doula delivery companionship,percutaneous electrical stimulation,and other measures between two groups were compared,and there were not significant differences(all P>0.05).(3)Analgesia related conditions and VAS scores of women undergoing vaginal delivery:compared with the single-tube epidural block group(n=40),the second-partum time of the women in the double-tube epidural block group(n=59)was significantly shortened[(124±44)vs(86±33)minutes,P<0.01];after 30 minut

关 键 词：镇痛 硬膜外 镇痛 产科 利多卡因 剖宫产术 分娩发动 预后 

分 类 号：R714.3[医药卫生—妇产科学]