硬膜外麻醉镇痛对自然分娩产程及结局的影响  

Effect of epidural anesthesia and analgesia on the course and outcome of spontaneous labor

作　　者：张洁[1] 方微园 李爱红 ZHANG Jie;FANG Weiyuan;LI Aihong(Department of Gynecology and Obstetrics,Minhang Hospital,Fudan University(Shanghai Minhang District Central Hospital),Shanghai 201199,China;Department of Infectious Diseases,Children’s Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属闵行医院(上海市闵行区中心医院)妇产科,上海201199 [2]复旦大学附属儿科医院感染传染科,上海201102

出　　处：《上海医药》2024年第9期65-68,82,共5页Shanghai Medical & Pharmaceutical Journal

基　　金：上海市闵行区卫健委课题(2019MW10)。

摘　　要：目的:探讨硬膜外麻醉镇痛对自然分娩产程及结局的影响。方法:回顾性分析197例孕妇资料,根据产次和分娩镇痛与否分为初产妇镇痛组(n=79)、初产妇对照组(n=44)、经产妇镇痛组(n=45)和经产妇对照组(n=29),比较组间疼痛视觉模拟(VAS)评分、产程时间、产后2 h出血量、新生儿Apgar评分、剖宫产率等。结果:初产妇镇痛组VAS评分和剖宫产率低于对照组,但第二产程时间长于对照组(均P<0.05),其他指标差异无统计学意义。经产妇镇痛组VAS评分低于对照组(P<0.05),其他指标差异无统计学意义。结论:硬膜外麻醉镇痛均可缓解初、经产妇产痛,延长初产妇第二产程,并可降低初产妇剖宫产率,然而对其他产程、产后出血量、新生儿Apgar评分均无显著影响。Objective:To investigate the effect of epidural anesthesia and analgesia on the process and outcome of spontaneous labor.Methods:The data from 197 pregnant women were retrospectively analyzed,and they were divided into a primigravid analgesia group(n=79),a primigravid control group(n=44)and a transplacental analgesia group(n=45)and a transplacental control group(n=29)according to the number of labor and the presence or absence of analgesia in labor.The visual analogue score(VAS)of pain,duration of labor,hemorrhage in postpartum 2 h,neonatal Apgar score,and the cesarean section rate were compared among the groups.Results:The VAS score and the caesarean section rate was lower and the duration of the second stage of labor was longer in the primigravida analgesia group than the control group(all P<0.05),and the differences in other indicators were not statistically significant.The VAS score of the transplacental analgesia group was lower than that of the control group(P<0.05),and the differences in other indicators were not statistically significant.Conclusion:Epidural anesthesia analgesia can relief labor pain of primiparous and transient women,extend the second stage of labor of primiparous women and reduce the rate of caesarean section in primiparous women,however,it has no significant effect on the other stages of labor,postpartum hemorrhage and neonatal Apgar score.

关 键 词：硬膜外麻醉 镇痛分娩 产程时间 分娩结局 剖宫产率 

分 类 号：R614.42[医药卫生—麻醉学] R714.3[医药卫生—外科学]