分娩镇痛对产程及分娩结局的影响

Effect of painless childbirth on labor and delivery outcomes

目的 探讨分娩镇痛对产程以及分娩结局的影响.方法 选择2010年5月至2013年3月于浙江省慈溪市妇幼保健院行分娩镇痛的产妇120例作为观察组,给予蛛网膜下腔阻滞麻醉（腰硬联合麻醉）阻滞镇痛,选择同期于本院未施行分娩镇痛的产妇100例作为对照组.对2组产妇的分娩疼痛程度、各产程时间和分娩结局进行比较.结果 观察组疼痛0级和1级的比例分别为15.0％ （18/120）和75.0％（90/120）,明显高于对照组[0,10.0％ （10/100）],2级和3级的比例分别为10.0％ （12/120）和0,明显低于对照组[71.0％ （71/100）,19.0％ （19/100）],且差异有统计学意义（x2=16.34、92.95、86.39、24.96,均P＜0.05）;观察组产妇的第一、三产程和总产程的时间均明显短于对照组[（309±45） min比（368±54） min,（6.5±0.7）min比（7.0±1.1）min,（370±49） min比（421±60）min]（t =8.781、4.086、6.936,均P＜0.05）,而第二产程的时间明显长于对照组[（55±13）min比（47±14）min]（f=4.497,P＜0.05）;观察组中转剖宫产发生率为8.3％（10/120）,明显低于对照组（18.0％,18/100）,差异有统计学意义（x2=4.589,P＜0.05）;观察组新生儿Apgar评分明显高于对照组,差异有统计学意义[（9.3±1.3）分比（8.4±1.2）分]（t=5.294,P＜0.05）.观察组胎儿窘迫、新生儿窒息及产妇产后岀血量比较,差异均无统计学意义（均P＞0.05）.结论 腰硬联合阻滞分娩镇痛可有效减轻产妇疼痛,缩短总产程时间,减少剖宫产率,改善分娩结局.

Objective To explore the effect of painless childbirth on production process and birth oot-comes.Methods All 120 cases of maternal with painless childbirth were as the observation groupand 100 cases of maternal without painless delivery were as the control group.The maternal childbirth pain,time of every labor and birth outcomes in the two groups were compared.Results The proportion of pain 0 level （15.0%） and 1 level （75.0%） in observation group was significantly higher than that in the control group （0,10.0%）; 2 level （10.0%） and 3 level （0.0%） in observation group were significantly less than those in the control group （71.0%,19.0%） （x2 =16.34,92.95,86.39,24.96,all P〈0.05）.The time of first stage,the third stage of labor and the total process of maternal in observation group were significantly shorter than those in the control group[（309 ±45）min vs （368 ±54）min,（6.5 ±0.7）min vs （7.0 ± 1.1）min,（370 ±49） min vs （421 ± 60） min] （t =8.781,4.086,6.936,P 〈 0.05） ; the time of second stage labor was significantly longer than that in the control group [（55 ± 13） min vs （47 ± 14） min] （t =4.497,P 〈 0.05）.The proportion of transit cesarean section in observation group （8.3%）was significantly less than that in the control group（18.0%） （x2 =4.589,P 〈 0.05）.Apgar score in observation group was significantly higher than that in the control group [（9.3 ± 1.3） scores vs （8.4 ± 1.2） scores],the difference was statistically significant （t =5.294,P 〈 0.05）.Conclusion Epidural block for labor analgesia can effectively reduce maternal pain,shorten the total production process,reduce the cesarean section rate and improve birth outcomes.