腰麻-硬膜外联合麻醉对胎头位置异常初产妇分娩结局的影响

Clinical Analysis of the Effect of Combined Spinal Epidural Anesthesia for Delivery Outcomes of Primiparae with Abnormal Fetal Head Position

目的分析腰麻-硬膜外联合麻醉对胎头位置异常初产妇分娩结局影响。方法选取我院2014年6月~2015年12月期间产房待产胎头位置异常初产妇120例,随机分为观察组（n=60,行腰麻-硬膜外联合麻醉）和对照组（n=60,不使用麻醉镇痛）。详细记录两组产妇胎位转复分娩率、剖宫产率、器械助产使用情况、缩宫素使用情况、产程时间、镇痛效果、新生儿窒息、新生儿出生后1 min、5 min时的Apgar评分、产后2 h内出血量、排尿情况和并发症情况。结果观察组第一产程、总产程时间、剖宫产率、器械助产和缩宫素的使用素均低于对照组,有统计学意义（均P〈0.05）;观察组产妇胎位转复分娩率和镇痛有效率高于对照组产妇（均P〈0.05）;且观察组未出现新生儿窒息,对照组新生儿窒息2例（5.1%）,两组产妇比较无统计学意义（P〉0.05）。结论胎头位置异常的初产妇分娩时应用腰麻-硬膜外联合麻醉镇痛效果佳,能有效的减轻产妇的疼痛,降低剖宫产率,对产妇和胎儿均无不良影响,安全性较高。

Objective To analyze the effect of combined spinal epidural anesthesia for delivery outcomes of primiparae with abnormal fetal head position. Methods The clinical records of 120 delivery outcomes of primiparae with abnormal fetal head position between June 2014 and December 2015 were studied. They were randomly divided into the observation group received spinal epidural anesthesia（ n = 60） and control group using routine treatment without anesthesia（ n = 60）. The vital signs,duration of labor,mode of delivery,oxytocin consumption rate,midwifery rate and the neonatal Apgar＇s score were recorded and compared. Results It showed significant superiority in the time of the first stage of labor and total stage of labor,the transfer rate of Cesarean section,the oxytocin consumption rate and the midwifery rate in the observation group（ P〈 0. 05）.The fetal asphyxia neonatorum rate of the control group was 5. 1%,which had no difference with the observation group（ P 〈0. 05）. Conclusion It showes good analgesic effect in the delivery outcomes of primiparae with abnormal fetal head position using combined spinal epidural anesthesia,which can effectively relieve the maternal pain and reduce the rate of Cesarean section. It also shows safety on the basis of no maternal and fetal injury.