蛛网膜下腔阻滞联合硬膜外阻滞对产妇分娩方式及母婴结局的影响

Effect of subarachnoid space block anesthesia combined with epidural anesthesia on delivery modes and maternal- infant outcomes

目的探究蛛网膜下腔阻滞联合硬膜外阻滞对产妇分娩方式及母婴结局的影响。方法根据产科镇痛方法将产科分娩镇痛的80例产妇分为硬膜外组(硬膜外阻滞)和联合组(蛛网膜下腔阻滞联合硬膜外阻滞),另选取120例同期未实行镇痛分娩产妇为对照组,对比分析3组分娩方式、产程时间变化、母儿合并症及麻醉后不良反应的发生情况。结果联合组和硬膜外组产钳助产率均高于对照组,剖宫产率低于对照组,差异有统计学意义(P<0.05);联合组阴道顺产率高于对照组和硬膜外组,产钳助产率低于硬膜外组,差异有统计学意义(P<0.05);联合组和硬膜外组活跃期延长、活跃期停滞、第二产程延长及胎儿窘迫发生率均高于对照组(P<0.05),而联合组和硬膜外组之间差异无统计学意义(P>0.05);联合组麻醉阻滞后头痛、皮肤瘙痒和低血压的发生率显著高于硬膜外组(P<0.05)。结论蛛网膜下腔阻滞联合硬膜外阻滞可降低剖宫产率和提高阴道顺产率,但是提高了产钳助产率,且与产程中活跃期延长、活跃期停滞、第二产程延长及胎儿窘迫的发生有关。

Objective To explore the effect of subarachnoid space block anesthesia combined with epidural anesthesia on delivery modes and maternal-infant outcomes. Methods Eighty women receiving labor analgesia were divided into epidural anesthesia group （epi- dural anesthesia） and combined analgesia group （combined subarachnoid epidural analgesia, CSEA）, 120 women not receiving labor analge- sia during the same period were selected as control group. The delivery modes, changes of time of stages of labor, maternal-infant complica- tions, and adverse reactions after analgesia in the three groups were compared and analyzed. Results The rates of forceps delivery in com- bined analgesia group and epidural anesthesia group were higher than that in control group, the rates of cesarean section were lower than that in control group, there were statistically significant differences （ P〈0.05 ） ; the rate of vaginal delivery in combined analgesia group was high- er than those in control group and epidural anesthesia group, the rate of forceps delivery was lower than that in epidural anesthesia group, there were statistically significant differences （ P〈0.05 ） ; the rates of prolonged active phase, protracted active phase, prolonged the second stage of labor, and fetal distress in combined analgesia group and epidural anesthesia group were statistically significantly higher than those in control group （ P〈0.05 ） , but there was no statistically significant difference between combined analgesia group and epidural anesthesia group （P〉0. 05） ; the incidence rates of headache, pruritus, and hypotension in combined analgesia group were statistically significantly higher than those in epidural anesthesia group （ P〈0. 05 ） . Conclusion CSEA can reduce cesarean section rate and improve vaginal delivery rate, but it also improves forceps delivery rate, and it is correlated with prolonged active phase, protracted active phase, prolonged the second stage of labor, and fetal distress.