硬膜外麻醉分娩镇痛对初产妇会阴侧切率和产后疼痛的影响

The study on labor epidural analgesia in reducing lateral episiotomy rate and delivery analgesia for primipara

目的：探讨硬膜外麻醉分娩镇痛在初产妇中的应用效果。方法将176例分娩初产妇采用数字表法分为观察组和对照组，每组88例。对照组给予非药物分娩镇痛法，观察组给予硬膜外麻醉分娩镇痛，记录两组分娩方式和镇痛效果。结果观察组干预后焦虑自评量表评分（42．65±1．87）分，抑郁自评量表评分（45．76±3．05）分，对照组干预后焦虑自评量表评分（46．34±3．88）分，抑郁自评量表评分（51．93±4．95）分，组间差异均有统计学意义（t＝8．036、9．954，均P＜0．05）。观察组产妇活跃期血浆皮质醇（31．06±3．67）nmol／L，第一产程VAS评分（1．88±0．45）分，第二产程VAS评分（3．54±1．32）分，第三产程VAS评分（2．43±1．19）分；对照组产妇活跃期血浆皮质醇（38．76±5．22）nmol／L，第一产程VAS评分（2．78±0．96）分，第二产程VAS 评分（4．86±3．15）分，第三产程VAS 评分（3．85±2．21）分，组间差异均有统计学意义（t＝11.3199、7．963、3．625、5．307，均 P＜0．05）。观察组产妇产后出血量（186．71±32．18）mL，会阴侧切率为14.78％，新生儿窒息率1．14％；对照组产妇产后出血量（254．82±45．96）mL，会阴侧切率为35．23％，新生儿窒息率7．95％，组间差异均有统计学意义（t＝11．387，χ2＝9．818、4．714，均P＜0．05）。结论硬膜外麻醉分娩镇痛应用在初产妇中能够减轻产妇负性心理压力，减轻产程中疼痛程度，降低会阴侧切率和产后出血发生，改善母婴结局，提升母婴安全，值得在临床上推广应用。

Objective To explore the application effect of epidural labor analgesia for primipara.Methods 176 labor primipara were divided into observation group and control group by digital table.The control group was given non-drug labor analgesia,the observation group was given epidural labor analgesia.The analgesic effects of the two groups of childbirth way were recorded.Results After the intervention,in the observation group,the anxiety self-assessment rating scale,depression self rating scale score were （42.65 ±1.87）points,（45.76 ±3.05）points, which in the control group were （46.34 ±3.88）points,（51.93 ±4.95）points,there were statistically significant differences between the two groups（t=8.036,9.954,all P〈0.05）.In the observation group,the ＆quot;active＆quot;maternal plasma cortisol,the first stages of VAS score,the second labor VAS score,the third labor VAS score were （31.06 ± 3.67）nmol/L,（1.88 ±0.45）points,（3.54 ±1.32）points,（2.43 ±1.19）points,which in the control group were （38.76 ±5.22）nmol/L,（2.78 ±0.96）points,（4.86 ±3.15）points,（3.85 ±2.21）points,there were statistically significant differences between the two groups（t=11.319,7.963,3.625,7.963,all P〈0.05）.In the observation group,the maternal postpartum haemorrhage amount,episiotomy rate,neonatal asphyxia rate were （186.71 ± 32.18）mL,14.78%,1.14%,which in the control group were （254.82 ±45.96）mL,35.23%,7.95%,there were statistically significant differences between the two groups（t=11.387,χ2 =9.818,4.714,all P〈0.05）.Conclusion Epidural labor analgesia application in primipara can reduce maternal negative psychological stress,relieve labor pain degree,reduce episiotomy rate and postpartum hemorrhage occurs,improve and outcomes and improve maternal and child safety,it is worth popularization and application in clinic.