硬膜外分娩镇痛时间对轻度子痫前期产妇住院期间产后高血压的影响  

Impact of epidural analgesia duration on postpartum hypertension in mild preeclampsia patients during hospitalization

作　　者：沈杰 温俊坚 黄健雄 胡祖荣[1] SHEN Jie;WEN Jun-jian;HUANG Jian-xiong;HU Zu-rong(Department of Anesthesiology,Guangdong Women and Children Hospital,Guangzhou 510180,Guangdong,China)

机构地区：[1]广东省妇幼保健院麻醉科,广东广州510180

出　　处：《广东医学》2024年第9期1198-1202,共5页Guangdong Medical Journal

基　　金：广州市科技计划项目(202201011648)。

摘　　要：目的探讨硬膜外分娩镇痛(LEA)时间与轻度子痫前期(PE)产妇住院期间高血压发生的相关性。方法选择2021年1月至2023年12月于广东省妇幼保健院产科经阴道分娩的轻度PE产妇。根据产妇在分娩过程中LEA时间分成C组(未接受LEA)、S组(LEA时间≤3 h)和L组(LEA时间>3 h)。分别比较3组间产后48 h和产后住院期间高血压发生率及发生次数,采用多因素logistic回归分析LEA时间长短和产后48 h高血压发生的关系。结果研究纳入243例轻度PE产妇,其中C组45例,S组97例,L组101例。3组产妇在年龄、体质指数(BMI)、孕周、糖尿病、产前重度高血压、围产期降压药使用情况、麻醉开始和结束时的阻滞平面以及产后住院时间上差异并无统计学意义(P>0.05)。L组在LEA用药量上高于S组,且围产期补液入量高于C组和S组(P<0.05),在产后48 h的高血压发生率、高血压发生次数和住院期间的高血压次数低于C组和S组(P<0.05)。通过logistic回归模型调整了围产期降压使用后,LEA时间>3 h与产后48 h期间高血压发生率降低相关(P<0.05)。结论LEA时间>3 h与轻度PE产妇产后48 h高血压发生降低相关。Objective To investigate the correlation between the duration of epidural labor analgesia(LEA)and the incidence of postpartum hypertension in patients with mild preeclampsia(PE)during hospitalization.Methods A retrospective analysis was conducted on patients with mild PE who underwent vaginal delivery at Guangdong women and Children Hospital between January 2021 and December 2023.Patients were divided into three groups based on LEA duration:Group C(no LEA),Group S(LEA duration≤3 hours),and Group L(LEA duration>3 hours).The incidence and frequency of hypertension within 48 hours postpartum and during hospitalization were compared among the three groups.Multivariate logistic regression was used to analyze the relationship between LEA duration and the incidence of hypertension within 48 hours postpartum.Results A total of 243 mild PE patients were included:45 in Group C,97 in Group S,and 101 in Group L.There were no significant differences among the three groups in terms of age,body mass index(BMI),gestational age,diabetes,pre-delivery severe hypertension,use of perinatal antihypertensives,blockade levels at the start and end of anesthesia,or postpartum hospital stay(P>0.05).Group L had higher LEA drug doses and higher perinatal fluid intake compared to Groups C and S(P<0.05).The incidence and frequency of hypertension within 48 hours postpartum and during hospitalization were lower in Group L compared to Groups C and S(P<0.05).After adjusting for the use of perinatal antihypertensives,logistic regression analysis indicated that LEA duration>3 hours was associated with a reduced incidence of hypertension within 48 hours postpartum(P<0.05).Conclusion A duration of LEA>3 hours is associated with a reduced incidence of postpartum hypertension in patients with mild PE within 48 hours postpartum.

关 键 词：子痫前期 硬膜外阻滞 分娩镇痛 产后高血压 

分 类 号：R614[医药卫生—麻醉学] R714[医药卫生—外科学]