硬膜外阻滞分娩镇痛不同时机的临床观察

The observation of different starting time of epidural block analgesia during labor

目的探讨在第一产程不同时段施行硬膜外阻滞镇痛对产程及母婴并发症的影响。方法随机选择153例无妊娠合并症、骨盆内测量无异常、要求行分娩镇痛的足月初产妇,分成观察组3组:A组,临产后宫口开大<1 cm;B组,宫口≥1 cm且≤2 cm者;C组,宫口>2 cm且<4 cm。D组(对照组),同期分娩,条件与观察组相当,未行分娩镇痛者100例。分别记录产程时限,自然分娩率,缩宫素使用率,阴道助产及剖宫产率,监测产后出血量及新生儿Apgar评分。结果观察组B组、C组剖宫产率均低于对照组,其缩宫素使用率,阴道助产率,产后出血量、新生儿Apgar评分与对照组比较,差异无统计学意义(P>0.05)。其中B组总产程短于其它3组;A组总产程与对照组比较,差异无统计学意义(P>0.05),自然分娩率低于对照组,其缩宫素使用率,阴道助产率,产后出血量均高于对照组,新生儿Apgar评分低于对照组。结论临产后,宫口开大≥1 cm进行分娩镇痛,对分娩过程及分娩结局均无不良影响,既能有效地缩短产程,又能有效地降低剖宫产率。

Objective To study the effect of epidural block analgesia on labor and maternal and neonatal complication during different starting time of the first stage of labor. Methods 153 term primiparaes without pregnancy complications and abnormal internal pelvimetry who required delivery analgesia were randomly assigned into 3 groups ： group A （ n = 40） received analgesia when uterus cervix is 〈 1 cm ; group B （n = 41 ） received analgesia when uterus cervix 1 -2 cm; group C （n = 72） received analgesia when uterns cervix 2 -4 cm; group D （control group, n = 100） did not receive analgesia whose conditions were as well as the observation group during the same period. We calculate and compared the time of labor course, the rates of natural delivery, oxytocin usage, vaginal delivery, cesarean section, the amount of postpartum hemorrhage and neonatal Apgar score among 4 groups. Results The cesarean section rate in observation groups B and C was lower than that of control group. There was no significant difference for oxytocin usage, vaginal delivery rate, postpartum hemorrhage and neonatal Apgar score in groups B and C compared with control group. The total labor stage of group B was shorter than the other three groups. There was no significant difference between group A and control group in the total stage. The rate of natural delivery in group A was lower than that of control group. The rates of oxytocin usage, vaginal delivery and the amount of postpartum hemorrhage in group A were higher than that in control group. The neonatal Apgar score in group A was lower than that of control group. Conclusion No adverse effects of labor analgesia was found on delivery process and outcome when uterus cervix opened to more than 1 cm. It could shorten labor stage and decrease the cesarean section rate effectively.