导乐陪伴联合硬膜外镇痛提高阴道分娩率的临床观察

Clinical observation on improving success rate of vaginal delivery by doula labor combined with epidural analgesia

目的探讨导乐(助产士全程陪伴)联合硬膜外镇痛(EA)分娩对产程及分娩方式的影响。方法选择临产妇243例(镇痛组)实施导乐联合EA分娩,同期常规阴道分娩临产妇262例为对照组。镇痛组硬膜外镇痛用药为0.075%罗哌卡因与0.5μg/ml舒芬太尼混合液。比较两组产痛、产程时间、缩宫素应用、分娩方式和新生儿Apgar评分。结果镇痛组镇痛效果满意,第一、三产程VAS评分均<1分,第二产程VAS评分为(3.2±0.6)分。镇痛组第一产程活跃期时间明显短于对照组[(135.1±57.9)min vs.(189.9±71.5)min](P<0.05)。与对照组比较,镇痛组阴道分娩率高,剖宫产率低,但缩宫素使用率高(P<0.05或P<0.01)。两组产后出血量和新生儿Apgar评分相仿(P>0.05)。结论导乐联合EA分娩可有效减轻产妇分娩疼痛,提高阴道分娩成功率,对母婴无明显不良影响。

Objective To investigate the effects of doula labor（accompanied by midwife in the whole course of delivery,D） combined with epidural analgesia（EA） on the progress and mode of labor.Methods DEA with 0.075% ropivacaine plus sufentanil 0.5 μg/ml was performed in 243 primiparas undergoing vaginal delivery（group A）.The labor pain,duration of labor,oxytocin administration,delivery mode and Apgar scores were recorded and compared to those in 262 primiparas without D and EA（group B）.Results The pain relief during labor was satisfectory in group A with VAS scores less than 1 point in the first and third stage and（3.2±0.6） points in the second stage of delivery.The duration of active period of the first stage was shorter in group A than that in group B [（135.1±57.9） min vs.（189.9±71.5） min]（P0.05）.The vaginal delivery rate was higher,Ceasarean section rate was lower,but oxytocin use was more,in group A than those in group B（P0.05 or P0.01）.There were no significan differencecs in Apgar scores and postpartum hemorrhage between two groups.Conclusion D and EA can effectively attenuate labor pain and increase vaginal delivery rate without any adverse effect on the maternal and neonate.