分娩镇痛在剖宫产后阴道试产中的应用效果

Application effect of intraspinal anesthesia during trial of labor after cesarean

目的研究椎管内麻醉在剖宫产后阴道试产(TOLAC)中对母儿的影响。方法选取2014年7月至2017年2月在铜陵市妇幼保健院分娩的249例TOLAC的产妇作为研究对象,选择分娩镇痛的产妇134例作为镇痛组,未选择的产妇115例作为对照组,观察其分娩时间、镇痛效果、产后出血量、分娩结局、中转剖宫产指征、缩宫素情况、新生儿有无窒息、产时及分娩后的相关不良反应、分娩后满意度。结果镇痛组和对照组共194例产妇自然分娩成功,对照组剖宫产率高于镇痛组(χ2=14.90,P<0.05);在剖宫产指征中因"社会因素"手术的孕妇,镇痛组显著少于对照组(χ2=26.72,P<0.05)。镇痛组和对照组自然分娩的产妇第一产程时间分别为(418.72±144.32)min、(495.00±162.37)min,比较差异有统计学意义(t=3.43,P<0.01);与对照组相比,镇痛组在视觉模拟评分(VAS)方面具有优势(z=3.53,P<0.05),缩宫素使用率高(χ2=5.37,P<0.05),产妇满意情况也显著优于对照组(χ2=9.91,均P<0.05)。镇痛组自然分娩的产妇发热、瘙痒的发生率均高于对照组自然分娩产妇(发热:P=0.00;瘙痒:χ2=6.07,P<0.05),而恶心呕吐两组间比较差异无统计学意义(P>0.05)。结论椎管内麻醉在TOLAC分娩中能够有效减轻产妇因生产过程而带来的痛苦,同时有效缩短生产过程,且不会增加产后出血等不良反应,明显降低剖宫产率,不会出现严重并发症,使产妇满意度增加。

Objective To investigate the effect of intraspinal anesthesia on mothers and neonates during trial of labor after cesarean（TOLAC）.Methods Totally 249 cases of TOLAC were selected as subjects from Tongling Woman and Child Health Care Hospital during July 2014 to February 2017,among whom 134 cases accepting delivery anesthesia were recruited in anesthesia group and115 cases not accepting anesthesia were selected in control group.Some situations were observed in two groups including delivery time,analgesia effect,blood loss after delivery,delivery outcomes,indications for transforming cesarean,utilization of oxytocin,asphyxia,adverse reactions during and after delivery,and satisfactory degree after delivery.Results Natural delivery was accomplished in 194 cases in two groups,and the cesarean section rate in the analgesia group was significantly lower than in the control group（χ2=14.90,P〈0.05）.In the analgesic group the cases undergoing surgery due to social factors were significantly fewer than those in the control group（χ2=26.72,P〈0.05）.The first stage of labor was 418.72±144.32 min and 495.00±162.37 min in the analgesia group and in the control group,respectively,and the difference was significant（t=3.43,P 0.01）.Compared to the control group,the analgesia group had advantage in VAS（z=3.53,P〈0.05）,higher utilization rate of oxycotin（χ2=5.37,P〈0.05）,and higher satisfactory among patients（χ2=9.91,P〈0.05）.The incidence of fever and itching in the analgesia group was significantly higher than that in the control group,but there was no significant difference in incidence of vomit and nausea（P〉0.05）.ConclusionIntraspinal anesthesia could significantly reduce maternal pain,shorten labor stage,not increase the rate of adverse reactions such as postpartum hemorrhage,and reduce caesarean rate without severe complications,and the satisfactory increases among patients.