潜伏期不同时机硬膜外镇痛对产程和剖宫产率的影响

Influences of Different Timing of Epidural Analgesia in Latent Phase of Labor on Progress of Labor and Incidence of Cesarean Section

目的探讨潜伏期实施硬膜外分娩镇痛的最佳时机以及对产程、分娩方式的影响。方法选择初产妇240例,将80例不愿行分娩镇痛者为对照组(A组),160例自愿要求分娩镇痛者按随机数字表法分为B、C 2组,每组80例。A组按产科常规处理,B组在宫口开大1cm时实施镇痛,C组在宫口开大2cm时实施镇痛。均选L2-3为穿刺点,镇痛液配方为0.085%罗哌卡因和0.5μg·mL-1舒芬太尼混合液,背景输注10mL·h-1,单次PCA量5mL,锁定时间30min,宫口开大8cm时停用镇痛泵。观察记录各组产妇各时段VAS评分、产程时间、分娩方式、新生儿Apgar评分、产后出血量、缩宫素使用情况及产妇满意度等。结果与A组比较,B、C 2组在宫口开大3、8、10cm时VAS评分均明显降低,第一产程时间明显缩短、剖宫产率明显下降(均P<0.05)。B、C 2组产妇满意度评分均明显高于A组,B组高于C组(均P<0.05)。3组新生儿出生5min时Apgar评分、产钳助产率、产后出血量及缩宫素使用率比较差异均无统计学意义(均P>0.05)。结论第一产程潜伏期宫口开大1cm和2cm时实施硬膜外镇痛对产程和分娩方式无明显的影响,能明显缩短第一产程时间和降低剖宫产率,但宫口开大1cm时实施镇痛产妇满意度更高。

Objective To investigate the optimal timing for epidural analgesia in latent phase of labor,and to observe its influence on labor progress and delivery mode.Methods A total of 160 uniparas who voluntarily requested labor analgesia were randomly divided into group B and group C,with 80 uniparas in each group.In addition,80 uniparas who did not want to receive labor anal-gesia were selected as the controls（group A）.Uniparas in group A were given conventional ob-stetric management.In group B and C,epidural analgesia was initiated when the cervix was dilated 1 and 2 cm,respectively.The puncture was performed at L2-3 .The mixed liquor of 0.085% ropiv-acaine and 0.5μg·mL-1 sufentanil was administered via the patient controlled epidural analgesia pump（background infusion 10 mL·hour,bonus 5 mL,lockout time 30 minutes）.The analgesia was stopped when the cervix was dilated 8 cm.Visual analogue scale（VAS）score,labor progress, delivery mode,neonatal Apgar score,postpartum hemorrhage,oxytocin use and maternal satisfac-tion were record in all three groups.Results Compared with group A,VAS score at 3,8 and 1 0 cm cervical dilation,duration of the first stage of labor and incidence of cesarean section signifi-cantly decreased in group B and group C（all P〈0.05）.Compared with group B,maternal satisfac-tion decreased in group A but increased in group C（all P〈0.05）.There were no significant differences in neonatal Apgar score at 5 minutes after birth,instrumental delivery rate,postpar-tum hemorrhage and oxytocin use among the three groups（all P＆gt;0.05）.Conclusion The imple-mentation of epidural analgesia at 1 or 2 cm cervical dilation can shorten the duration of the first stage of labor and reduced the incidence of cesarean section.There were no significant differences in labor progress and delivery mode between uniparas receiving epidural analgesia at 1 cm cervical dilation and uniparas receiving epidural analgesia at 2 cm cervical dilation.However,uniparas re-ceiving epidural analgesia at 1 cm cervical dilation have higher satisfaction than uniparas receiving epidural analgesia at 2 cm cervical dilation.