全程硬膜外分娩镇痛用于妊娠期高血压产妇自然分娩可行性分析

Feasibility of whole - range epidural labor analgesia for parturient women with pregnancy - induced hypertension in natural delivery

目的探讨全程硬膜外阻滞分娩镇痛对患有妊娠期高血压疾病产妇自然分娩结局及应激激素水平的影响。方法选择妊娠期高血压疾病产妇80例,随机分为两组,各40例,全程分娩镇痛组(A组),活跃期分娩镇痛组(B组)行分娩镇痛,两组操作过程完全一致。采用视觉模拟疼痛评分(visual analogue score,VAS),记录镇痛前及镇痛后直至宫口开全时的疼痛评分,以及产程潜伏期、活跃期、第二产程、第三产程持续时间、宫缩药使用情况、分娩结局、产时出血量。产妇满意度及新生儿评分。两组分别于规律宫缩(T_0),宫口开大3 cm(T_1),宫口开全(T_2)胎儿娩出(T_3)抽取产妇静脉血,采用放射免疫法测定肾上腺素(adrenaline,ADR)皮质醇(cortisol,COR)的浓度,同时测定产妇血压,计算平均动脉压(mean arterial preasure,MAP)。结果镇痛前的VAS评分,A组低于B组(P<0.05),行分娩镇痛后两组VAS评分及产程各阶段持续时间,分娩方式,产时出血量,缩宫素使用率,新生儿Apgar评分胎儿窘迫发生率组间差异无统计学意义(P>0.05),缩宫素使用时间,A组高于B组(P<0.05)。B组T_1 ADR、COR的浓度及MAP高于T_0及A组,同时点且有统计学意义(P<0.05)。结论全程硬膜外分娩镇痛应用于妊娠期高血压疾病产妇全产程中ADR、COR没有进一步升高,降低了剧烈产痛产生的应激反应,故可以阻止妊娠高血压疾病的病情恶化,且不增加剖宫产率,疗效确切,不良反应少,使妊娠期高血压疾病产妇阴道分娩更加安全。

Objective To investigate the effect of whole - range epidural analgesia on the outcome of natural labor and on the level of stress hormone in parturient women with pregnancy - induced hypertension （PIH）. Methods Eighty parturient women with PIH were randomly divided into two groups according to the time of analgesia initiation, with 40 in each group. Whole - range labor analgesia group （group A） and active group （group B） used the same procedure for analgesia. Visual analogue score （VAS） , the analgesic result, latent phase and active phase of labor, duration of the second stage and third stage of labor, oxytocin dose, outcome of la- bor, intra - partum hemorrhage, degree of satisfaction of pregnancy, neonatal Apgar score, concentrations of ADR and COR in different stages of labor in maternity venous blood and mean arterial pressure （MAP） of parturient women were recorded. Results The two groups were significantly different in VAS before analgesia （ P 〈 0. 05 ） , but were not so after analgesia in terms of the duration of each stage of labor, modes of delivery, intra - partum hemorrhage, oxytocin dose, neonatal Apgar score, MAP and the concentrations of adrenaline （ADR） and cortisol （COR） in To stage （ P 〉 0. 05 ）. However, there was significant difference in MAP and the concentrations of ADR and COR between stage T1 and To in group B （ P 〈 0. 05 ）. Conclusions Whole range epidural analgesia reduces stress reaction resulting from labor pain in parturient women with PIH, prevents the deterioration of PIH without increasing the rate of caesarean section, shows fewer side effects and makes safer vaginal delivery of parturient women with P1H.