椎管内阻滞麻醉分娩镇痛的时机选择对产程及母婴结局的影响  

The Influence of Timing of Labor Analgesia under Spinal Block Anesthesia on Labor Course and Maternal and Infant Outcomes

作　　者：熊小娟 万佳 张春花[1] XIONG Xiaojuan;WAN Jia;ZHANG Chunhua(The First Hospital of Nanchang,Nanchang 330008,China)

机构地区：[1]南昌市第一医院,江西南昌330008

出　　处：《中国医学创新》2023年第8期134-138,共5页Medical Innovation of China

基　　金：江西省卫生健康委科技计划项目(202211569)。

摘　　要：目的:研究椎管内阻滞麻醉分娩镇痛的时机选择对产程及母婴结局的影响。方法:选择南昌市第一医院产科2021年6月-2022年5月120例产妇,采用随机数字表法分为四组,每组30例,A组和B组均于宫口扩张≤3 cm时行椎管内镇痛,A组在宫口开全后停止镇痛;B组在宫口开全后继续镇痛;C组和D组均于宫口扩张>3 cm时行椎管内镇痛,C组在宫口开全后停止镇痛;D组在宫口开全后继续镇痛。记录各组产妇各产程时间及母婴结局。结果:各组第一产程、第二产程和总产程用时比较差异均有统计学意义(P<0.05)。各组第三产程用时差异无统计学意义(P>0.05)。组间两两比较:A组、B组第一产程和总产程用时均明显长于C组、D组;A组、C组第二产程用时均明显短于B组、D组,差异均有统计学意义(P<0.05)。A组与B组,C组与D组第一产程和总产程用时差异均无统计学意义(P>0.05)。A组与C组,B组与D组第二产程用时差异均无统计学意义(P>0.05)。C组、D组顺产率分别为93.33%、93.33%,均高于A组、B组的70.00%、70.00%;C组、D组催产素使用率分别为33.33%、26.67%,均低于A组、B组的56.67%、53.33%;差异均有统计学意义(P<0.05)。B组与A组,D组与C组顺产率、催产素使用率差异均无统计学意义(P>0.05)。各组新生儿窒息率、产后2 h出血量、出生后1、5、10 min新生儿Apgar评分差异均无统计学意义(P>0.05)。各组下肢麻木、尿潴留、痛痒、发热恶心等并发症发生率比较差异均无统计学意义(P>0.05)。结论:宫口扩张>3 cm时全程椎管内分娩镇痛是较适宜的镇痛方法,可缩短产程,对母婴结局的影响较小。Objective:To study the effect of the timing of labor analgesia under spinal block anesthesia on labor course and maternal and infant outcomes.Method:A total of 120 puerperae in the Obstetrics Department of the First Hospital of Nanchang from June 2021 to May 2022 were selected and randomly divided into four groups by digital table method,with 30 cases in each group.In group A and group B,intraspinal analgesia was performed when cervical dilation≤3 cm.Group A stopped analgesia after dilation of the cervix;group B continued analgesia after dilation;group C and group D received intraspinal analgesia when the dilation of the cervix was greater than 3 cm.Group C stopped analgesia after dilation;group D continued analgesia after dilation.The duration of labor and maternal and infant outcomes were recorded in each group.Result:There were statistically significant differences in the time spent in the first stage of labor,the second stage of labor and the total stage of labor among the groups(P<0.05).There was no significant difference in the duration of the third stage of labor among the groups(P>0.05).Pairwise comparison between groups:the first stage of labor and total labor time in group A and group B were significantly longer than those in group C and group D;the second stage of labor in group A and group C were significantly shorter than those in group B and group D,the differences were statistically significant(P<0.05).There were no significant difference in the first stage of labor and total labor time between group A and group B,group C and group D(P>0.05).There were no significant differences in the duration of the second stage of labor between group A and group C,group B and group D(P>0.05).The vaginal delivery rates of group C and group D were 93.33%and 93.33%,respectively,which were higher than 70.00%and 70.00%of group A and group B.The use of Oxytocin in group C and group D was 33.33% and 26.67%, respectively, which were lower than 56.67% and 53.33% ofgroup A and group B, the differences were statistically

关 键 词：椎管内分娩镇痛 时机 产程 分娩结局 

分 类 号：R714.3[医药卫生—妇产科学]