双管法镇痛对胎头位置异常产妇分娩结局的影响

Analysis of effect of double catheter analgesia on delivery outcome of fetal head malposition

目的探讨双管法硬脊膜外镇痛对胎头位置异常产妇分娩结局及分娩方式的影响。方法选取2015年9月-2016年6月该院产科进行阴道试产的127例胎头位置异常产妇进前瞻性行研究,采用随机数字表法分为单管组、双管组,63例采用单管法硬脊膜外镇痛(单管组)、64例采用双管法硬脊膜外镇痛(双管组),对比两组的分娩结局及分娩方式。结果双管组的阴道分娩率64.06%高于单管组的46.04%(P<0.05);双管组的剖宫产率23.44%和缩宫素使用率60.94%低于单管组的41.27%和90.48%,差异均有统计学意义(P<0.05);两组阴道分娩产妇分娩镇痛前的宫口大小、第三产程差异无统计学意义(P>0.05);双管组的第一、第二产程均低于单管组,差异有统计学意义(P<0.05);两组产妇的产后出血量、尿潴留发生率差异无统计学意义(P>0.05)。两组产妇的两组新生儿体重、第1及5分钟的Apgar评分差异无统计学意义(P>0.05)。结论双管法硬脊膜外镇痛有利于提高胎头位置异常产妇阴道分娩率,同时缩短产程。

Objective To investigate the effect of double catheter epidural analgesia on the delivery outcome of fetal head malposition and the mode of delivery. Methods For prospective study, 127 puerperants of fetal head malposition with vaginal delivery were selected in the Department of Obstetrics in our hospital from September 2015 to June 2016, and divided into single tube group and double tube group randomly. The single catheter epidural analgesia was applied to 63 cases（single tube group）, while the double catheter epidural analgesia was applied to the remaining（double tube group）. The outcome and the mode of delivery were compared between the groups. Results The vaginal delivery rate of the double tube group（64.06%） was significantly higher than that of the single tube group（46.04%）（P〈0.05）. The cesarean section rate（23.44%）and the oxytocin utilization rate（60.94%） of the double tube group were significantly lower than those of the single tube group（41.27% and 90.48%, respectively）, the differences were statistically significant（P〈0.05）.There was no significant difference between the two groups in the size of the uterus or the third birth process before delivery（P〈0.05）. The first and the second stage of the double tube group were significantly lower than those of the single tube group, the difference were statistically significant（P〈0.05）. There was no statistically significant difference in maternal postpartum hemorrhage or the incidence of urinary retention between the two groups（P〈0.05）. There was no significant difference between the two groups in neonatal weight or the apgar score of the first and the fifth minute（P〈0.05）. Conclusions The double catheter epidural analgesia is helpful to improve the vaginal delivery rate in puerperants with fetal head malposition,and to shorten the production process as well.