硬膜外麻醉镇痛对初产妇产程及分娩结局的影响  

Effects of the epidural anesthesia and analgesia for primiparas on their stages of labor and delivery outcomes

作　　者：吴清清 蔡温和 WU Qingqing;CAI Wenhe(Hangzhou Obstetrics and Gynecology Hospital,Hangzhou,Zhejiang Province,310008)

机构地区：[1]浙江省杭州市妇产科医院,310008

出　　处：《中国计划生育学杂志》2024年第9期2064-2067,2073,共5页Chinese Journal of Family Planning

摘　　要：目的:探究硬膜外麻醉镇痛不同介入时机对初产妇产程进展与分娩结局的影响。方法:选取2023年1-12月在本院行阴道试产分娩的420例初产妇资料。其中240例实施分娩镇痛,依据镇痛时机分为潜伏期镇痛组(宫口扩张<4cm,120例)、活跃期镇痛组(宫口扩张≥4cm,120例)。未镇痛者列为对照(180例)。对比3组产程时间、分娩结局、软产道损伤及新生儿Apgar评分情况。结果:潜伏期镇痛组第一、第二产程及总产程时间均长于未镇痛组(q=4.71、6.57、6.02;P<0.05);活跃期镇痛组第一产程、总产程时间均短于潜伏期镇痛组(q=5.06、4.23;P<0.05);潜伏期镇痛组、活跃期镇痛组宫颈裂伤率、会阴侧切率均低于未镇痛组(χ^(2)=5.91、4.54、7.30、3.86;P<0.05);活跃期镇痛组胎窘发生率、中转剖宫产率均低于潜伏期镇痛组(χ^(2)=4.71、4.55;P<0.05),胎位异常发生率高于未镇痛组(χ^(2)=3.87;P<0.05),3组会阴Ⅱ度裂伤率、产后24h出血量、阴道助产率、新生儿Apgar评分对比均无差异(均P>0.05)。结论:硬膜外麻醉镇痛虽延长产程,但未增加新生儿不良结局及产后出血发生风险,且有助于降低宫颈裂伤及会阴侧切率。活跃期镇痛产妇总产程、胎儿窘迫、中转剖宫产发生率较潜伏期更低,故考虑宫口≥4cm为更适宜的镇痛时机。Objective:To explore the influence of the different intervention timing of the epidural analgesia for primiparas on their stages of labor and delivery outcomes.Methods:The data of 420 primiparas that had undergone vaginal trial delivery from January to December 2023 were selected in this study.Among them,240 cases were treated with labor analgesia and were divided into group A(120 cases with labor analgesia at their latent phase of the uterus orifice dilation<4cm)and active analgesia group(120 cases with labor analgesia at their active phase of the uterus orifice dilatation≥4cm)according to the timing of labor analgesia used.The other 180 primiparas who had not received labor analgesia were included in group C.The duration of labor,the delivery outcomes,the soft birth canal injuries,and the neonatal Apgar scores of the primiparas were compared among three groups.Results:The duration of the first,the second labor and the total labor time of the primiparas in group A were significantly longer than those of the primiparas in group C(q=4.71,6.57,6.02,P<0.05).The duration of the first and the total labor of the primiparas in group B were significantly shorter than those of the primiparas in group A(q=5.06,4.23,P<0.05).The rates of cervical laceration and episiotomy of the primiparas in group A and in goup B were significantly lower than those of the primiparas in group C(χ^(2)=5.91,4.54,7.30,3.86,P<0.05).The incidences of the fetal distress and the cesarean section of the primiparas in group B were significantly lower than those of the primiparas in group C(χ^(2)=4.71,4.55,P<0.05).The incidence of the fetal abnormal position of the primiparas in group B was significantly higher than that of the primiparas in group C(χ^(2)=3.87,P<0.05).There were no significant differences in the rates of theⅡdegree perineal laceration,the bleeding volume in 24 hours after delivery,the vaginal midwifery rate,and the neonatal Apgar scores of the primiparas among the three groups(all P>0.05).Conclusion:Although the epidural analge

关 键 词：初产妇 硬膜外麻醉 镇痛时机 产程 分娩结局 

分 类 号：R714.3[医药卫生—妇产科学]