持续硬膜外麻醉分娩镇痛对分娩四要素的影响

Effects on the labor four elements of continuous epidural analgesia in labor

目的探讨持续硬膜外麻醉分娩镇痛（以下简称分娩镇痛）对分娩四要素的影响。方法210例自然临产宫口开2 cm后自愿实施分娩镇痛的产妇，观察其实施分娩镇痛前后的产力、产道、胎儿、精神心理状况，给予数值化体现，并加以比较分析。结果分娩镇痛后子宫工作量先升后降、腹压减小（t=46.78，P〈0.01）、肛提肌力量减弱（t=20.99，P〈0.01）；分娩镇痛后宫颈内口变软（t=3.59，P〈0.01）、盆底肌肉力量变弱（t=66.90，P〈0.01）；分娩镇痛后胎心波动幅度较小（t=6.00，P〈0.01），出现减速的可能更多（t=6.85，P〈0.01）；分娩镇痛前后胎方位的变化，差异无统计学意义（χ2=6.00，P=0.30）；使用分娩镇痛后产妇疼痛程度降低（t=60.25，P〈0.01）、自控度升高（t=24.30，P〈0.01）、对生产过程的满意度也升高（t=36.61，P〈0.01）。结论分娩镇痛对产力、产道、胎儿、精神心理这4个分娩要素都造成了不同程度的影响，或促进或抑制或维持。

Objective To explore the influence of continuous epidural analgesia in labor （hereinafter referred to as labor analgesia） to the labor four elements. Methods The study included 210 parturients with analgesia during labor, form cervix opens 2 cm, based on the parturients＇ choose. Observe the differences in the labor analgesia parturients, through the force of labor and birth canal, fetal and psychology. Results The uterine-work after analgesia showed a trend of rising first, then dropping, reduce abdominal pressure （t=46.78, P 〈 0.01）, and the contractive ability of musculus levator ani （t= 20.99, P 〈 0.01）; Soften uterus cervix （t=3.59, P 〈 0.01） and reduced the pelvic floor muscle convergent force （t=66.90, P〈0.01）; Decreased the fetal heart rate range （t=6.00, P〈0.01）, increased fetal heat deceleration times （t=6.85, P〈0.O1）. The differences in the position of fetus was not statistically significant （X^2=6.00, P 〈 0.01）; Lower the pain score in the labor stage （t=60.25, P 〈 0.01）, increased the self-control score during the labor （t=24.30, P 〈 0.01） and the satisfaction score during the labor, after analgesia （t=36.61, P 〈 0.01）. Conclusions The labor analgesia influenced labor elements, include the force of labor and birth canal, fetal and psychology, or promote or restrict or maintain.