可行走式分娩镇痛对子宫收缩及产程、分娩结局的影响分析

Analysis of the effect of ambulatory labor analgesia on contraction,labor and birth outcomes

目的分析可行走式硬膜外阻滞分娩镇痛对子宫收缩、产程的影响,为推广应用可行走式硬膜外阻滞分娩镇痛提供依据。方法选取2015年1至12月在新疆石河子市妇幼保健院住院自然分娩的单胎足月初产孕妇120例,根据患者自愿原则分为两组,有分娩镇痛要求的60例作为镇痛组,无分娩镇痛要求行常规分娩的60例作为对照组。镇痛组宫口开大3cm时行硬膜外阻滞分娩镇痛;对照组常规分娩,不行分娩镇痛。结果 ①镇痛组产妇镇痛后各时间点NRS评分均较对照组降低（P〈0.05）10min、15min、30min、60min、120min、t/P值分别为-3.256/0.031、-6.134/0.004、-5.218/0.006、-7.137/0.002、-7.107/0.002。镇痛起效时间10.5±6.4min;②子宫收缩持续时间：镇痛后10~60min镇痛组宫缩持续时间较对照组缩短（P〈0.05）,10min、15min、30min、60min、t/P值分别为-2.487/0.016、-2.224/0.029、-3.013/0.004、-4.185/0.000,镇痛后120min两组宫缩持续时间差异无统计学意义（P〉0.05,t/P值为-0.234/0.816）;③子宫收缩间隔时间：镇痛后60min镇痛组较对照组宫缩间隔时间延长（P〈0.05）,χ^2/P值为14.253a/0.003,镇痛后120min两组宫缩间隔时间无显著差异（P〉0.05）,χ^2/P值为0.244/0.970;④两组产程时间及分娩结局比较：镇痛组潜伏期较对照组延长（P〈0.05）,t/P值2.261/0.026,两组活跃期、第二产程时间比较无显著差异（P〉0.05）,t/P值分别为0.298/0.767、-0.374/0.709,镇痛组催产素使用率较对照组高（P〈0.05）,χ^2/P值为5.635/0.028,两组出血量比较无显著差异（P〉0.05）,t/P值为0.693/0.490。两组新生儿阿氏评分比较无显著差异（P〉0.05）,t/P值为0.189/0.851。结论硬膜外阻滞分娩镇痛效果确切。对宫缩在一定时间内有一过性减弱。在严密观察下合理使用催产素,不延长产程,不增加新生儿窒息率及产后出血,对母婴安全,值得临床推广应用。

Objective To analyze the effect of ambulatory labor analgesia by epidural anesthesia on uterine contraction and labor so as to provide evidence for the promotion of ambulatory epidural block for labor analgesia. Methods From January to December in 2015,120 cases of singleton full term primiparas with natural childbirth hospitalized in Xinjiang Shihezi Maternity and Child Health Care Hospital were selected. According to voluntary principle 60 patients treated with labor analgesia were in analgesia group and 60 with routine delivery without labor analgesia in control group. Labor analgesia through epidural block was given to the analgesia group when cervix up to 3 cm,while the control group conducted natural delivery without analgesia. Results The NRS scores at 10 m,15m,30 m,60m and 120 m in the analgesia group after analgesia were lower than those in the control group（ t value was- 3. 256,- 6. 134,- 5. 218,- 7. 137 and- 7. 107,respectively,and P value was 0. 031,0. 004,0. 006,0. 002 and 0. 002,respectively,all P〈0. 05）. The analgesia onset time was 10. 5 ± 6. 4 min. The duration of uterine contraction of the analgesia group after 10 to 60 minutes of analgesia was shorter than that of the control group（ P〈0. 05,t value was- 2. 487,- 2. 224,- 3. 013 and- 4. 185,respectively,P value was 0. 016,0. 029,0. 004 and0. 000,respectively at 10 m,15m,30 m and 60m）. The difference in duration of uterine contractions between two groups after 120 min of analgesia was not statistically significant（ P〉0. 05,t =- 0. 234,P = 0. 816）. The contraction interval of the analgesia group was extended compared to the control group after 60 min of analgesia（ P〈0. 05,χ^2= 14. 253 a,P = 0. 003）. The difference in contraction interval of two groups after 120 min of analgesia had no significant difference（ P〉0. 05,χ^2= 0. 244 a,P = 0. 970）. The labor and delivery outcomes were compared between two groups. Incubation period of the analgesic group was longer（ P〈0. 05,t = 2. 261,P = 0. 026）. Active period and duration of the second stage between two groups had no significant differences（ P〉0. 05,t value was 0. 298 and- 0. 374,respectively,P value was 0. 767 and 0. 709,respectively）. Incidence of oxytocin usage was higher in the analgesia group than the control group（ P〈0. 05,χ^2= 5. 635,P = 0. 028）. Difference in bleeding amount between two groups had no significance（ P〉0. 05,t = 0. 693,P = 0. 490）. Neonatal Apgar scoring had no significant difference between two groups（ P〉0. 05,t = 0. 189,P = 0. 851）. Conclusion The effect of epidural block labor analgesia is exact. The contraction is transiently weakened in a certain time by analgesia. With the rational use of oxytocin under close observation labor will not prolong,and the incidence of neonatal asphyxia and postpartum hemorrhage is not increased. It is safe to mother and infant,and is worthy of clinical popularization and application.