肥胖产妇硬膜外镇痛分娩术后腰痛原因分析及对策

Research on the low back pain complication of morbidly obese parturient with epidural analgesia in labor

目的探讨肥胖产妇硬膜外镇痛分娩术后出现腰痛的原因及对策。方法随机选择50例健康产妇作为A组(正常对照组),筛选100例符合肥胖产妇诊断标准的产妇,随机选择50例分B组(肥胖组),随机选择50例分为C组(肥胖处理组),A、B两组按常规给予硬膜外镇痛分娩处理,C组采用导乐陪伴分娩,并于术前采用B超预先定位,在B超引导下硬膜外穿刺置管,术后给予腰部理疗处理。术后对所有出现腰痛并发症产妇进行核磁共振成像检查。最后对3组产妇的镇痛效果,麻醉满意度和术后腰痛等并发症发生情况进行对比分析。结果在导乐陪伴及B超下进行硬膜外穿刺麻醉镇痛的肥胖产妇产后出现腰痛并发症的发病率降低,麻醉镇痛效果好,腰椎软组织损伤等并发症低。核磁共振成像分析发现肥胖患者腰痛并发症与椎间盘退行性改变及关节韧带松弛改变有关。结论肥胖产妇硬膜外镇痛分娩术后疼痛的原因与反复穿刺损伤局部软组织以及本身椎间盘退行性变及关节韧带松弛有关,肥胖产妇术前导乐陪伴分娩以及B超定位指导穿刺对减少肥胖产妇术后腰痛并发症有帮助。

Objective To explore the reasons of low back pain complication of morbidly obese parturient with epidural analgesia in labor and the methods of avoiding this complication. Methods 50 healthy parturients were randomly selected as healthy control group （A group）,100 morbidly obese parturients were randomly divided into morbidly obese control group （B group） and morbidly obese treated group （C group）. A and B groups were treated with routine epidural anal- gesia in lobor, the C group was treated with doula accompany joint epidural analgesia guiding by ultrasonic position transpiercing. All parturients with the complication of low back pain were treated with MRI exam. Results The morbidly obese parturients treated with doula accompany joint epidural analgesia guiding by ultrasonic position transpiercing group were compared with control group, the complication of low back pain was significantly decreased in treaded group. Analgesic efficacy was excellent in treated group. The rate of lumbar soft injury was much lower in treated group and the processes time of transpiercing was much short. There were no other serous complications in treated group. The MRI exam showed the lumbar intervertebral disc degeneration and lumbar soft injury were two main reasons of low back pain complication in morbidly obese parturients. Conclusion Doula accompany joint epidural analgesia guiding by ultrasonic position transpiercing in morbidly obese labor are very effective methods in avoiding low back pain in our context.