硬膜外分娩镇痛对产程和分娩结局的影响

Effect of Epidural Labor Analgesia on Labor and Delivery Outcome

目的观察硬膜外镇痛对产程和分娩结局的影响。方法对我院2013年10月至2014年8月2 406例产检正常并选择阴道试产的单胎初产妇资料进行回顾性分析,根据是否使用硬膜外镇痛分为两组。统计两组活跃期、第二产程、第三产程和总产程时间,产妇结局和新生儿结局。结果镇痛组活跃期、第二产程、总产程平均用时较对照组长,产后2 h平均出血量明显大于对照组(P<0.05)。镇痛组自然分娩率、剖宫产率分别为70.36%、29.18%,新生儿1 min、5 min Apgar评分≤7发生率为1.37%、0.61%,羊水胎粪污染Ⅱ度、Ⅲ度发生率为0.30%、0.15%,与对照组比较,差异无统计学意义(P>0.05)。结论硬膜外分娩镇痛会延长产程时间,但对分娩结局无明显影响。

Objective To observe the influence of epidural analgesia on labor duration and delivery outcome. Methods The clinical data of 2 406 cases of primipara with single fetus and normal production inspection in our hospital from October 2013 to August 2014 were analyzed retrospectively. All cases were divided into analgesia group（n = 658, epidural analgesia） and control group（n = 1 748, without epidural analgesia）. The times of active phase of labor, second stage and third stage, total duration of labor, maternal outcome, and neonatal outcome were observed and compared between two groups. Results The time of active phase of labor, second stage time and total duration of labor of analgesia group were significantly longer than those of control group, and the average blood loss 2 hours after delivery was significantly more than that of control group（all P〈0.05）. The natural birth rate and cesarean section rate of analgesia group were 70.36%and 29.18% respectively; the incidences of neonatal 1stmin and 5thmin Apgar score ≤ 7 of analgesia group were 1.37% and 0.61%respectively; the incidences of Ⅱ degree and Ⅲ degree of meconium stained amniotic fluid of analgesia group were 0.30% and 0.15%respectively; compared with the control group, all P〈0.05. Conclusions Epidural analgesia can prolong the duration of labor, but has no significant effect on delivery outcomes.