初产妇中期妊娠引产持续硬膜外麻醉对再孕及结局影响队列研究  

A cohort study on the effects of continuous epidural anesthesia of primiparas with the second trimester of pregnancy during induction of labor on their pregnancy again and their next pregnancy outcomes

作　　者：陈林[1] 苏杰 佘永军 CHEN Lin;SU Jie;SHE Yongjun(The Second Hospital of Tangshan,Tangshan,Hebei Province,063015;Cang County Hospital,Cangzhou City of Hebei;Tang County People's Hospital(The Fourth Central Hospital of Baoding))

机构地区：[1]河北省唐山市第二医院,063015 [2]河北省沧州市沧县医院 [3]河北省唐县人民医院(保定市第四中心医院)

出　　处：《中国计划生育学杂志》2022年第9期2035-2039,共5页Chinese Journal of Family Planning

摘　　要：目的:采用双向性队列研究方法探讨持续硬膜外麻醉对中期妊娠引产初产妇效果及再妊娠结局的影响。方法:于2017年12月展开。回顾性收集2014年1月-2015年12月本院接收的自愿行中期妊娠(孕周15~24周)引产初产妇病历资料,查阅以“中期引产手术中使用持续硬膜外麻醉方法”者为镇痛组(291例),以“常规中期引产术,并无任何相关镇痛操作”为对照组(312例),随访资料≥2年(回顾性队列);2017年12月通过查阅病历和电话随访引产术后再孕情况,对再孕成功者进行前瞻性再孕母婴结局观察(前瞻性队列)。分析回顾性和前瞻性两队列不同术中镇痛者2~3年内再孕及结局。结果:回顾性队列及前瞻性队列,随着引产手术进行产妇疼痛评分(VAS)均逐渐增高,但镇痛组低于对照组,术后出血量镇痛组(100.3±8.5 ml)均低于对照组(123.1±8.4 ml)(均P<0.05),但运动障碍、腰痛、头痛等不良反应发生率均很低两组无差异(P>0.05)。随访2年,回顾性队列失访率3.3%、前瞻性队列1.3%,再生育意愿比例镇痛组略高于对照组但无统计学差异,再孕成功率前瞻性队列中镇痛组(91.9%)高于对照组(80.6%)(P<0.05)。随访孕后分娩母婴情况,分娩方式及新生儿Apgar评分两组无差异(P>0.05),新生儿体重镇痛组(3478.6±229.7g)低于对照组(3610.3±247.2g)(P<0.05)。结论:持续硬膜外麻醉镇痛能有效减低中期妊娠引产疼痛及产后出血量,对短期再孕母婴预后影响不大。Objective:To discuss the effects of continuous epidural anesthesia during induction of labor of primipara with the second trimester of pregnancy on their pregnancy again and their next pregnancy outcomes by a two-way cohort study.Methods:The study was launched in December 2017.The medical history data of the parturients who were had accepted the induction of labor during the second trimester of pregnancy(15-24 gestational weeks)from January 2014 to December 2015 were collected retrospectively.291 parturients with continuous epidural anesthesia during induction of labor were included in group A,and 312 parturients without any anesthesia treatment during induction of labor were included in group B.The parturients with data≥2 years of followed up retrospectively were included in group C.In December 2017,and the situation of re-pregnancy of the parturients after induction of labor was collected by looking up their medical record and telephone consulting during follow-up.Prospective cohort study was conducted in the parturients with re-pregnancy successful in group D.Then the re-pregnancy within 2-3 years and their repregnancy outcomes of the parturient with different anesthesia methods in group C and group D were analyzed prospectively.Results:The visual analogue scale(VAS)of the parturients in group C and group D had increased gradually with the conducting of induction of labor,and which of the parturients in group A was significantly lower than that of the parturients in group B.The postoperative blood loss(100.3±8.5 mL)of the parturients in group A was significantly lower than that(123.1±8.4 ml)of the parturients in group B(all P<0.05).The incidences of adverse reactions,such as movement disorders,low back pain,and headache of all the parturients were very low,and which of the parturients had no significant different between group A and group B(P>0.05).After 2 years of follow-up,the loss rate of follow-up of the parturients in group C was 3.3%,and that of the parturients in group D was 1.3%.The proportion of r

关 键 词：中期妊娠引产 初产妇女 持续硬膜外麻醉 镇痛 生育意愿 再妊娠结局 

分 类 号：R719.3[医药卫生—妇产科学]