椎管内分娩镇痛围产安全及其对产妇盆底功能的影响  

Perinatal safety of intraspinal delivery analgesia and its influence on maternal pelvic floor function

作　　者：江桥英 刘阳[3] 郭心 齐彩霞 黄雅青 JIANG Qiaoying;LIU Yang;GUO Xin;QI Caixia;HUANG Yaqing(Affiliated People′s Hospital of Hangzhou Medical College,Hangzhou 310016,China;Department of Obstetrics,Zhejiang Provincial People′s Hospital,Hangzhou 310016,China;Qingdao Medical College,Qingdao University,Qingdao 266071,China)

机构地区：[1]杭州医学院附属人民医院,浙江杭州310016 [2]浙江省人民医院产科,浙江杭州310016 [3]青岛大学青岛医学院,山东青岛266071

出　　处：《中国现代医生》2021年第31期75-79,共5页China Modern Doctor

基　　金：浙江省卫生健康科技计划项目(2021KY032)。

摘　　要：目的探讨椎管内分娩镇痛对产妇及新生儿的围产安全及对产妇盆底功能的影响。方法回顾分析2017年10月至2019年1月于我院足月临产分娩的509例产妇的年龄、孕产次、分娩方式、第一产程时间、第二产程时间、第三产程时间及总产程时间,新生儿出生体重、Apgar评分、产后2 h及24 h出血量、产后出血发生率、会阴侧切、产钳助产及阴道裂伤情况、产时是否人工破膜、是否加用催产素、是否出现发热、产后是否出现尿潴留、羊水性状等相关信息,其中经产妇235例,初产妇274例。产妇产后42 d进行盆底肌评估。结果对经产妇而言,椎管内置管镇痛可显著延长第二产程(P<0.05),而对初产妇,除外第二产程,分娩镇痛还将显著延长第一产程及总产程时长(P<0.01)。尽管椎管内置管镇痛延长产程时间,但其不影响产妇产后盆底功能,产后漏尿情况比较,差异无统计学意义(P>0.05)。就围产安全而言,椎管内分娩镇痛并不增加产后出血及尿潴留风险,可显著降低产妇中转剖宫产、会阴侧切及裂伤风险,但也增加产程中人工破膜、缩宫素使用、产钳助产及产时发热比例(P<0.05)。对新生儿而言,分娩镇痛虽然增加孕妇发生宫内羊水性状改变风险,但并不增加胎儿宫内窘迫、新生儿窒息风险(P>0.05)。结论椎管内分娩镇痛虽会延长产妇产程,增加阴道助产风险,但不增加盆底功能受损风险,有利于产妇阴道分娩;除引起产时发热,对母婴无明显不良影响。Objective To explore the effect of intraspinal delivery analgesia on the perinatal safety of parturients and newborns and pelvic floor function of parturients.Methods A retrospective analysis was conducted on 509 parturients who gave full-term birth in our hospital from October 2017 to January 2019 to collect the age,number of pregnancy and delivery,delivery method,time of the first stage of delivery,time of the second stage of delivery,time of the third stage of delivery,total delivery time,newborn birth weight,Apgar score,bleeding volume at 2 hours and 24 hours postpartum,incidence of postpartum hemorrhage,lateral perineal resection,forceps assisted delivery and vaginal laceration,artificial rupture of the membrane during delivery,use of oxytocin,fever,urinary retention,and amniotic fluid after delivery.There were 235 multiparas and 274 primiparas included.The pelvic floor muscle assessment was done 42 days after delivery.Results The second stage of delivery was significantly prolonged by spinal canal analgesia in multiparas(P<0.05),while in in primiparas,except for the second stage,the first stage and total delivery time were significantly extended(P<0.01).Although the delivery time was prolonged by intraspinal canal analgesia,the postpartum pelvic floor function of the parturients was not affected,and there was no significant difference in postpartum urine leakage(P>0.05).In terms of perinatal safety,intraspinal analgesia did not increase the risks of postpartum hemorrhage and urinary retention.It significantly reduced the risks of transitioning to cesarean section,perineal incision,and laceration,and increased the artificial membrane rupture and contraction during delivery,proportion of oxytocin use,forceps assisted delivery,and fever during delivery(P<0.05).For newborns,although delivery analgesia increased the risk of intrauterine amniotic changes in pregnant women,it did not increase the risks of fetal distress and neonatal asphyxia(P>0.05).Conclusion Although intraspinal analgesia prolongs the delivery p

关 键 词：椎管内置管 分娩镇痛 初产妇 经产妇 盆底功能 

分 类 号：R714.3[医药卫生—妇产科学]