三种椎管内潜伏期分娩镇痛方法镇痛效果及分娩结局的比较

Comparison of analgesic effect and delivery outcome of three intraspinal labor analgesia methods used in latent phase of the first stage of labor

目的比较三种椎管内潜伏期分娩镇痛方法的镇痛效果及分娩结局。方法回顾性分析我院接受潜伏期分娩镇痛的单胎、足月、初产妇1 365例,采用三种镇痛方法将其分为A组(双管硬膜外阻滞,423例)、B组(单管硬膜外阻滞,436例)、C组(腰-硬联合阻滞,506例)。分析指标:①第一产程活跃期(T1)、第二产程(T2)、第三产程时间(T3);②产妇疼痛视觉模拟(VAS)评分;③中转剖宫产率、缩宫素使用率、会阴侧切率、器械助产率;④出院6周复查时相关并发症。结果①A组较B、C组,T1、T2缩短(P<0.05),三者T3差异无统计学意义(P>0.05);②A组较B组及C组分娩时VAS评分明显降低(P<0.05),B、C两组差异无统计学意义(P>0.05);③剖宫产率、缩宫素使用率、会阴侧切率、器械助产率A组明显低于B、C组(P<0.05),而B、C两组之间差异无统计学意义(P>0.05);④三组产妇腰背痛发生率比较差异无统计学意义(P>0.05),且无其他相关并发症。结论双管硬膜外阻滞用于分娩潜伏期镇痛的镇痛效果及对分娩结局的影响优于单管硬膜外阻滞及腰-硬联合阻滞。

Objective To compare the analgesic effect and delivery outcome of three intraspinal labor analgesia methods used in latent phase of the first stage of labor.Methods A retrospective analysis was made to 1 365 cases of singleton full-month primipara who were treated with latent phase labor analgesia in our hospital during 5 years.In accordance with the analgesic methods,those primiparas were divided into double pipes epidural block group（group A） of 423 cases,single pipe epidural block group（group B） of 436 cases,combined spinal epidural block group（group C） of 506 cases.Analysis index： ①time of the active phase of the first stage of labor,the second stage of labor,the third stage of labor;②maternal pain visual analogue score（VAS）;③interim cesarean section rate,rate of oxytocin use,lateral episiotomy rate,instrumental delivery rate;④related complications discharged 6 weeks.Results ①Time of the active phase of the first stage of labor and the second stage of group A was shorter than that of group B and group C（P 0.05）.Time of the third stage was not different among group A,group B and group C（P 0.05）.Labor time of group B and group C had no difference（P 0.05）.②VAS score of group A was significantly reduced than group B and group C（P 0.05）,VAS score of group B and group C had no difference（P 0.05）.③Cesarean section rate,rate of oxytocin use,lateral episiotomy rate,instrumental delivery rate of group A were significantly lower than those of group B and group C（P 0.05）,those between group B and group C had no differences（P 0.05）.④Incidence of pregnant backache and lumbago among three groups had no differences（P 0.05）,and there was no other related complication.Conclusion Analgesic effect and delivery outcome of double pipes epidural block is superior to single pipe epidural block and combined spinal epidural block.