椎管内分娩镇痛在剖宫产术后再次妊娠阴道分娩中的应用

Intrathecal Labor Analgesia in Vaginal Birth After Cesarean Section

目的探讨椎管内分娩镇痛用于剖宫产术后再次妊娠阴道分娩(vaginal birth after cesarean section,VBAC)的可行性和安全性。方法回顾性分析2016年1月~2017年3月于我院阴道分娩的剖宫产术后再次妊娠的单胎足月孕妇资料,其中接受椎管内分娩镇痛25例(镇痛组),43例未接受(非镇痛组)。2组产妇年龄、体重指数、分娩孕周、新生儿体重差异均无统计学意义(P>0.05)。比较2组产程时间、产后出血率、产后尿潴留率及新生儿窒息率。结果镇痛组镇痛后半小时的疼痛视觉模拟评分(2.2±1.0)分,显著低于镇痛前的(8.6±1.0)分(配对t检验,t=22.09,P=0.00)。2组第一产程时间、第二产程时间、产钳率、新生儿窒息率、产后出血率差异无统计学意义(P>0.05)。2组均无子宫破裂等严重并发症发生。结论椎管内麻醉应用于VBAC安全有效,在有条件的医院可推广应用。

Objective To investigate the feasibility and safety of the use of intrathecal labor analgesia in patients of vaginal birth after cesarean section(VBAC). Methods A retrospective study was conducted including 68 cases of full-term VBAC from January 2016 to March 2017.There were 25 cases of intrathecal labor analgesia(labor analgesia group)and 43 cases without analgesia(non-analgesia group).There was no significant difference in maternal age,BMI,gestational age,and birth weight between the two groups(P>0.05).The labor time,postpartum hemorrhage and neonatal asphyxia rate were recorded,respectively. Results The VAS scores in the labor analgesia group were significantly lower after analgesia[(2.2±1.0)points vs.(8.6±1.0)points,paired t-test,t=22.09,P=0.00].There was no significant difference in labor time of the first and second stage,use of obstetric forceps,neonatal asphyxia rate,and postpartum hemorrhage between the two groups(P>0.05).There were no severe complications such as uterine rupture in both groups. Conclusion The use of intrathecal labor analgesia in VBAC is safe and effective,and it is worthy of promoting in qualified hospitals.