腰硬联合阻滞麻醉行分娩镇痛对分娩第二产程的影响

Effects of combined spinal-epidural analgesia on second stage of labor

目的观察腰硬联合分娩镇痛(CSEA)对第二产程的影响。方法对西北妇女儿童医院2014年1月至2015年12月期间经阴道分娩产妇进行回顾性分析,采用多因素回归分析方法,研究腰硬联合分娩镇痛对第二产程的影响,并比较对镇痛组(CSEA组)与非镇痛组(非CSEA组)第一产程及第二产程时间的差异及产妇和胎儿的影响。结果共纳入研究对象11 994例,中5 748例(47.92%)产妇接受CSEA,6 246例(52.07%)产妇未实施CSEA。单因素分析结果显示CSEA组第一产程时间为(529.03±162.03)min,第二产程时间为(43.86±21.19)min,非CSEA组第一产程时间为(348.17±161.31)min,第二产程时间中位数为(33.95±18.14)min,CSEA组第一及第二产程均较非CSEA组延长(t值分别为-53.20、-23.75,均P<0.001)。CSEA组会阴侧切率为38.40%,显著高于非CSEA组(χ~2=28.65,P<0.05)。多因素分析结果显示,CSEA不增加二产程延长的风险(OR=0.839,95%CI:0.767~1.205,P=0.691)。另外,CSEA组会阴侧切率及器械助产率高于非CSEA组(χ~2=37.32,P<0.001),而新生儿5min Apgar评分及新生儿入院率在两组间无统计学差异(P=0.063),且CSEA组中转剖宫产率低于非CSEA组(χ~2=84.46,P<0.001)。结论虽然CSEA延长了第一及第二产程时间,但不增加第二产程延长风险,对新生儿无不良影响。

Objective To investigate the effects of combined spinal-epidural analgesia（ CSEA） on second stage of labor. Methods A retrospective study was conducted on puerperas undertaking vaginal delivery during the period of January 2014 to December 2015 in Northwest Women and Children Hospital. The effect of CSEA on second stage of labor was analyzed by using multivariable Logistic regression. And its influence on the difference in first and second stage of labor as well as maternal and neonatal outcomes was compared between CSEA group and non-CSEA group. Results During the study a total of 11 994 women were recruited,among whom 5 748（ 47. 92%） women received CSEA and 6 246（ 52. 07%） did not. Univariate analysis showed that the first stage of labor was 529. 03 ±162. 03 min and second stage of labor was 43. 86 ± 21. 19 min respectively in CSEA group,and that was 348. 17 ± 161. 31 min and 33. 95 ±18. 14 min respectively in non-CSEA group. The first and second stage of labor were longer in CSEA group than in non-CSEA group（ P 0. 001）. Episiotomy rate was 38. 40% in CSEA group,which was significantly higher than that in non-CSEA group（ χ~2 = 28. 65,P 0. 05）. Multivariable analysis showed CSEA did not increase the risk of prolonging second stage of labor（ OR = 0. 839,95% CI： 0. 767-1. 205,P = 0. 691）. In addition,episiotomy rate and instrumental midwifery rate were higher in CSEA group than in non-CSEA group（ χ~2 = 37. 32,P 0. 001）,but there were no significant differences in neonatal 5min Apgar score and neonatal admission rate between two groups（ P = 0. 063）. The rate transfer for cesarean section in CSEA group was lower than that in non-CSEA group（ χ~2 = 84. 46,P 0. 001）. Conclusion Although CSEA prolongs both the first and second stage of labor,it does not increase the risk of two stages of labor.And no adverse reaction is found on neonates.