蛛网膜下腔阻滞加硬膜外阻滞镇痛对产程、分娩方式及母儿预后的影响

Influence of combined spinal epidural analgesia and epidural analgesia on the progress of labor,delivery way and mothers and infants outcome

目的探讨蛛网膜下腔阻滞(腰麻)-硬膜外联合麻醉和产妇自控硬膜外镇痛(CSEA+PCEA)在分娩镇痛过程中对产程进展、分娩方式及母儿预后的影响。方法回顾性分析406例初产妇病历资料,观察组(CSEA+PCEA)共135例,对照组(产程中未采用任何镇痛措施)282例,比较两组产程经过、分娩方式及母儿结局。结果观察组活跃期及第二产程时间分别为(223.33±105.84)min、(58.74±33.15)min,对照组为(176.14±99.66)min、(46.71±33.69)min,两组比较有统计学意义(P<0.01);观察组出现产程中需缩宫素加强宫缩及活跃期停滞的发生率分别为60.00%、6.67%,对照组为27.68%、2.34%,两组比较有统计学意义(P<0.001、P=0.034);观察组剖宫产率(11.85%)、产程中尿潴留的发生率(55.56%)较对照组(分别为5.54%、33.58%)比较差异有统计学意义(P=0.024、P<0.001);难产手术(产钳助产+剖宫产)、羊水改变、第三产程、产后出血、新生儿Apgar评分、新生儿窒息及产后尿潴留的发生率两组比较差异均无统计学意义。结论CSEA+PCEA镇痛对产程进展存在一定的影响,但是对分娩结局及母儿的近期预后无明显影响。

Objective To study whether combined spinal-epidural analgesia（CSEA）and patient-control epidural analgesia（PCEA）has influence on labor progress,delivery way and mothers and infants outcome.Methods Cases data of 406 healthy nulliparas were retrospectively analyzed,study group（345 cases）accepted CSEA＋PCEA and control group（282 cases）without CSEA＋PCEA,to compare the labor progress,delivery way and the maternal and fetal outcome.Results The duration of active phase in the first stage and the second stage in the study group[（223.33 ±105.85）min,（59.29 ±33.155）min]were significantly longer than that of control group[（176.14±99.66）min,（46.71±33.69）]min（P〈0.01）,the rate of augmentation by oxytocin and the occurrence of arrested active phase in the study group（60.00%,6.67%）were significantly higher than that of control group（27.68%,2.34%）（P〈0.001,P=0.034）,The rate of cesarean section and urinary retention during labor in the study group（11.85%、55.56%）were significantly higher than that of control group（5.54%,33.58%）（P=0.024,P〈0.001）,No statistical difference was found between the two groups in the rate of dystocia（forceps delivery and cesarean section）,amniotic fluid changes,the duration of the third stage,the incidence of postpartum hemorrhage,the Apgar score of newborn,the occurrence of neonatal asphyxia and postpartum urine retention.Conclusion CSEA＋PCEA had adverse effect on labor progress,but it has no evident adverse effect on delivery way and mothers and infants outcome in the near future.