腰硬联合麻醉病人自控分娩镇痛下不同停泵时机对产程和分娩结局的影响

Study on the influence of labor process and delivery outcome with different duration of pump stop under epidural and patient-con-trolled analgesia

目的探讨腰硬联合麻醉病人自控分娩镇痛下不同停泵时机对产程和分娩结局的影响。方法选择经阴道分娩的初产妇共135例,分为第一、二、三产程持续镇痛组(A组),宫口开全停泵组(B组),宫口开全停泵、胎儿娩出后开泵组(C组),每组各45例。采用VAS评分法,在硬膜外注射前、注射后15 min、注射后45 min、宫口开全时、胎儿娩出后5 min比较各组患者疼痛情况,并观察产程时间和分娩结局。结果三组患者的第一产程、第二产程、第三产程时间均无统计学差异(P>0.05)。三组在硬膜外注射前、注射后15 min、注射后45 min、宫口开全后5 min的VAS评分均无统计学差异(P>0.05)。在胎儿娩出后5 min,B组VAS评分显著高于A组和C组;A组缩宫素使用比率显著高于B组和C组,差异均有统计学意义(P<0.05)。三组产后2 h出血量、新生儿Apgar评分比较,无统计学差异(P>0.05)。结论宫口开全停泵、胎儿娩出后开泵的方式既能达到减少产妇在第二、第三产程的分娩疼痛的效果,又不延长第二、三产程时间,也不增加缩宫素的使用和产后2 h出血量,是值得推荐的停泵时机选择。

Objective To explore the influence of labor process and delivery outcome under different duration of pump stop in epidural and patient-controlled analgesia. Methods 135 cases of vaginal delivery were collected and divided into 3 groups（ each group with 45 cases）.Patients in group A were at first,second and third stages of labor continuous analgesia; patients in group B were stopped pump while the whole cervix opened; patients in group C were stopped pump when whole cervix opened and opening pump after the fetus delivered. VAS scores were used to evaluate the situation of patient＇s pain before epidural injection,15 min and 45 min after injection,cervix full-dilated time,5 min after the fetus delivered. Full duration of labor and outcome of birth were observed and compared. Results The difference in duration of labor in first stage,second stage and third stage in these three groups of patients was not statistically significant（ P〉0.05）. In three groups,before epidural injection,15 min and 45 min after injection and 5 min after cervix opening,VAS scores in these 3groups were not statistically different（ P〉0.05）.VAS scores in group B at 5 min after the delivery of baby were significantly higher than those in group A and group C. The possibility of application of oxytocin in group A was significantly higher than that of group B and group C（ P〈0.05）,but the difference in 2 h post-partum bleeding and Apgar scores among these 3 groups was not significant. Conclusion The stopping of pump at whole cervix opened and opening pump after the delivery of fetus can not only reduce the maternal pain during second and third stages of labor,but it does not increase the dosage of oxytocin and extending the second and third stages of labor,thus the chance for stopping of the pump is worthy to be recommended.