分娩镇痛对剖宫产术后再次妊娠阴道分娩产程及母儿结局的影响研究  

Effect of labor analgesia on the labor duration and the maternal and neonatal outcome of vaginal delivery after cesarean section

作　　者：张宁[1] 张为远[2] 伍绍文[3] ZHANG Ning;ZHANG Wei-yuan;WU Shao-wen(Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院麻醉科,北京100026 [2]首都医科大学附属北京妇产医院/北京妇幼保健院围产医学部,北京100026 [3]首都医科大学附属北京妇产医院/北京妇幼保健院急诊科,北京100026

出　　处：《中国实用妇科与产科杂志》2023年第7期737-740,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：北京市科委首都临床特色应用研究(Z151100004015182);北京市医管中心2022年度培育计划(PG2022027)。

摘　　要：目的 探讨分娩镇痛对剖宫产术后再次妊娠阴道分娩(vaginal birth after cesarean,VBAC)产程及母儿结局的影响。方法 收集2015年1月至2019年3月于首都医科大学附属北京妇产医院围产医学部住院并分娩的VBAC孕妇共331例。按照产程中是否实施硬膜外麻醉分娩镇痛分为分娩镇痛组(121例)及无分娩镇痛组(210例),分析硬膜外麻醉分娩镇痛对产程及母儿结局的影响;进一步根据应用分娩镇痛时间,将分娩镇痛组分为长时限组(56例)和短时限组(65例),分析分娩镇痛应用时限对产程及母儿结局的影响。结果 (1)分娩镇痛的应用情况:121例(36.6%)使用分娩镇痛,分娩镇痛使用时限为0.7~13.5 h,平均5.3 h。(2)母儿结局:331例VBAC中无孕产妇及新生儿死亡。阴道分娩255例(77.0%),产钳助产76例(23.0%);50例(15.1%)发生产后出血,81例(24.5%)胎儿窘迫。无分娩镇痛组的新生儿体重明显小于分娩镇痛组(P<0.05),分娩镇痛组的第一产程、第二产程及总产程时限明显长于无分娩镇痛组(均P<0.05)。分娩镇痛组缩宫素使用率、产钳助产率及会阴侧切率明显高于无分娩镇痛组(均P<0.05)。两组产后出血发生率及胎儿窘迫发生率无明显差别(均P>0.05)。(3)长时限分娩镇痛组的第一产程、第二产程及总产程时限明显长于短分娩镇痛时限组(均P<0.05),但两组的缩宫素使用率、产钳助产率、产后出血及胎儿窘迫发生率无明显差异(均P>0.05)。结论 对有指征的剖宫产术后阴道试产(TOLAC)孕妇可以采用分娩镇痛,无论时限长短,母儿结局均良好,但可能延长VBAC产程,增加缩宫素使用、会阴切开及产钳助产率。Objective To explore the effect of labor analgesia on the labor duration and the maternal and neonatal outcome of vaginal delivery after cesarean section(VBAC).Methods Totally 331 VBAC pregnant women were collected in the Perinatal Department of Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2015 to March 2019.According to whether to use labor analgesia,they were divided into labor analgesia group(121 cases)and without labor analgesia group(210 cases).The effects of epidural analgesia on the labor duration and the maternal and neonatal outcomes were analyzed.Further,according to the time of labor analgesia,they were divided into long term group(56 cases)and short term group(65 cases) to analyze whether the application time of labor analgesia had different effects on the labor process and the maternal and fetal outcomes.Results(1) The application of labor analgesia:121 cases(36.6%) used labor analgesia.The duration of labor analgesia was 0.7-13.5 hours,with an average of 5.3 hours.(2) Maternal and neonatal outcomes:there were no maternal or neonatal deaths in 331 VBAC cases.There were 255 cases(77.0%) of vaginal delivery and 76 cases(23.0%) of forceps delivery;there were 50 cases(15.1%) of postpartum hemorrhage and 81 cases(24.5%) of fetal distress.The birth weight in the group without labor analgesia was significantly lower than that in the group with labor analgesia(P0.05),and the duration of the first stage,the second stage of labor,and the total labor duration in the group with labor analgesia was significantly longer than that in the group without labor analgesia(P0.05).The rates of oxytocin application,forceps-assisted delivery and perineum lateral incision in the group with labor analgesia were significantly higher than those in the without analgesia group(P0.05).There was no significant difference in the incidence of postpartum hemorrhage or fetal distress between the two groups(P0.05).(3)The first stage,the second stage and the total labor duration in the long term labo

关 键 词：剖宫产术后再次妊娠阴道分娩 分娩镇痛 产程 母儿并发症 

分 类 号：R714.4[医药卫生—妇产科学]