腰硬联合镇痛对高原地区经产妇分娩疼痛及应激反应的影响  

Effects of combined spinal-epidural analgesia on labor pain and stress response in multiparous women in high-altitude region

作　　者：谭娟 单志多吉 罗瑶 仓仁次决 米娜 迟晓慧[1] TAN Juan;Danzhiduoji;LUO Yao;Cangrencijue;MI Na;CHI Xiaohui(Teaching and Research Section of Anesthesiology,Tongji Hospital Affiliated to Tongji Medical college of Huazhong University of Science and Technology,Wuhan,Hubei,430030;Department of Surgical Anesthesiology,Shannan Maternal and Child Health Hospital of Xizang Autonomous Region,Shannan,Xizang,856099)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,湖北武汉430030 [2]西藏自治区山南市妇幼保健院手术麻醉科,西藏山南856099

出　　处：《实用临床医药杂志》2025年第4期83-86,91,共5页Journal of Clinical Medicine in Practice

基　　金：湖北省卫生健康委员会科研项目(WJ2023M023)。

摘　　要：目的探讨腰硬联合镇痛在高原地区经产妇分娩过程中的镇痛效果及其对产妇应激水平的影响。方法选取分娩经产妇86例为研究对象,按是否行分娩镇痛分为观察组43例和对照组43例。观察组在第一产程实施腰硬联合分娩镇痛。比较2组的疼痛情况[视觉模拟评分法(VAS)]、分娩心理体验[简化中文版分娩自我效能量表(CBSEI-C32)和分娩应对量表(CCB)]、应激水平[血清皮质醇(Cor)、去甲肾上腺素(NE)、脂联素(APN)]及其母婴结局。结果观察组第一产程、第二产程、第三产程时的VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组产后24 h的CBSEI-C32、CCB评分高于对照组,差异有统计学意义(P<0.05)。观察组产后12 h的血清Cor、NE、APN水平低于对照组,差异有统计学意义(P<0.05)。观察组不良母婴结局的发生率为0%,低于对照组的9.30%,差异有统计学意义(P<0.05)。结论在高原地区,腰硬联合镇痛技术在减轻经产妇分娩过程中的疼痛、改善分娩心理体验、降低应激水平以及减少不良母婴结局方面具有显著效果。Objective To investigate the analgesic effect of combined spinal-epidural analgesia and its impact on stress levels in multiparous women during labor in a high-altitude region.Methods A total of 86 multiparous women were enrolled as study subjects.They were divided into observation group(43 cases)and control group(43 cases)based on whether they received labor analgesia.The observation group received combined spinal-epidural analgesia during the first stage of labor.Pain levels[Visual Analogue Scale(VAS)],labor psychological experience[Chinese version of the Childbirth Self-Efficacy Inventory(CBSEI-C32)and Coping with Childbirth(CCB)],stress levels[serum cortisol(Cor),norepinephrine(NE)and adiponectin(APN)]as well as maternal and neonatal outcomes were compared between the two groups.Results The VAS scores during the first,second and third stages of labor were significantly lower in the observation group than those in the control group(P<0.05).The CBSEI-C32 and CCB scores at 24 hours postpartum in the observation group were significantly higher than those in the control group(P<0.05).The serum levels of Cor,NE and APN at 12 hours postpartum in the observation group were significantly lower than those in the control group(P<0.05).The incidence of adverse maternal and neonatal outcomes in the observation group was 0%,which was significantly lower than 9.30%in the control group(P<0.05).Conclusion In high-altitude regions,combined spinal-epidural analgesia is effective in reducing labor pain,improving labor psychological experience,lowering stress levels,and reducing adverse maternal and neonatal outcomes in multiparous women.

关 键 词：腰硬联合镇痛 高原地区 经产妇 分娩镇痛 应激水平 母婴结局 

分 类 号：R714.3[医药卫生—妇产科学] R614[医药卫生—临床医学] R246.3