蛛网膜下腔阻滞加硬膜外阻滞与单纯硬膜外阻滞对产程进展影响的分析

Influence of combined spinal-epidural analgesia and epidural analgesia on the progress of labor

目的探讨蛛网膜下腔阻滞(腰麻)加硬膜外阻滞与单纯硬膜外阻滞对产妇产程进展的影响。方法回顾性分析722例阴道分娩健康初产妇的临床资料,根据是否行分娩镇痛及分娩镇痛方法的不同分为3组:(1)腰麻加硬膜外阻滞(联合麻醉组),共259例;(2)单纯硬膜外阻滞(硬膜外组),共215例;(3)未采用任何镇痛方法的对照组,共248例。比较3组产妇产程时间及Friedman产程图进展变化特点。结果(1)第一产程活跃期、第二产程及第三产程时间比较:联合麻醉组分别为(272±127)min、(57±36)min及(9±6)min;硬膜外组分别为(305±133)min、(59±39)min及(8±6)min;对照组分别为(188±110)min、(45±32)min及(9±6)min。联合麻醉组及硬膜外组的第一产程活跃期及第二产程时间均长于对照组(P<0.01);3组间第三产程时间相互比较,差异均无统计学意义(P>0.05)。(2)产程图特点比较:联合麻醉组及硬膜外组产妇第一产程活跃期宫缩曲线位于产程图Friedman曲线右侧,对照组则位于其左侧;联合麻醉组和硬膜外组产程图宫口曲线较Friedman曲线倾斜角度小,即第一产程活跃期进展缓慢;对照组第一产程活跃期进展较快。联合麻醉组产妇平均每小时宫口开大1.5cm,硬膜外组产妇为1.4cm,对照组产妇为1.8cm。联合麻醉组及硬膜外组产妇平均每小时宫口开大程度较对照组缩小,两者比较,差异有统计学意义(P<0.01)。结论腰麻加硬膜外阻滞联合麻醉及单纯硬膜外阻滞镇痛后,产妇第一产程活跃期进展减慢,总产程时间延长;镇痛后的产程处理不应单纯按照Friedman产程图进行。

Objective To investigate the influence of combined spinal-epidural analgesia(CSEA) and epidural analgesia(EA) and patient-controlled epidural analgesia (PCEA) on labor progress. Methods The partograms of 722 healthy vaginal delivery nulliparas were retrospectively analyzed in Department of Obstetric and Gynecology, First Hospital of Peking University. Three groups were divided among all subjects: CSEA group (259 cases) receiving CSEA+PCEA,EA group(215 cases) receiving EA+PCEA and control group (248 cases) without any analgesia method. Results The duration of active phase in the first stage and the second stage in the CSEA group[(272±127)min and (57±36 )min] and in the EA group[(305±133)min and (59±39)min] were significantly longer than that of control group [(188±110)min and (45± 32) min]. No significant difference was found in the three groups in the duration of the third stage [CSEA: (9±6)min; EA: (8±6)min; Control: (9±6)min. P>0.05]. The dilatation curve of the cervix in CSEA group and EA group was plotted on the right side of the Friedman curve while that of the control group on the left, reflecting a slower progress in the former two groups than the control during the active phase. The average speed of cervical dilatation in CSEA and EA groups ( 1.5cm and 1.4cm) was significantly slower than that of the control(1.8cm) in the active phase(P<0.01). Conclusions CSEA+PCEA or EA+PCEA during labor might slow down the progress of the active phase and lead to a prolonged labor in the end. Therefore, the management of these parturients may vary based on Friedman partogram.