椎管内分娩镇痛在疤痕子宫再次妊娠阴道分娩中的临床应用

Clinical application of intraspinal delivery and dnalgesia in de-pregnancy vaginal delivery in scarred uterus

目的:探讨椎管内分娩镇痛在疤痕子宫再次妊娠阴道分娩(vaginal birth after cesarean section, VBAC)中的应用效果。方法:回顾性分析我院2016年9月至2018年1月收治的519例VBAC孕产妇临床资料,其中接受椎管内分娩镇痛产妇165例(研究组),未接受镇痛分娩产妇354例(对照组)。比较两组产妇的分娩方式,镇痛10 min、30 min、60 min时的宫缩持续时间以及宫口开至3 cm、8 cm、10 cm时的视觉模拟评分(Visual Analogue Scale/Score,VAS)。结果:研究组产妇阴道顺产比例明显高于对照组(P<0.05);两组产妇在研究组产妇镇痛10 min、30 min、60 min时的宫缩持续时间比较均无统计学意义(P>0.05)。其次,研究组产妇平均镇痛时间(5.11±1.47)h,当宫口开至8 cm和10 cm时,研究组产妇的VAS评分小于对照组,差异有统计学意义(P<0.05)。结论:椎管内分娩镇痛应用于VBAC能有效提高产妇自然阴道分娩率,并缓解产妇分娩疼痛。

Objective: o investigate the effect of intraductal delivery analgesia in VBAC. Methods: Retrospective analysis of 519 cases of VBAC maternal clinical data admitted in our hospital from September 2016 to January 2018, including 165 cases of intrapartum delivery analgesia (study group), and 354 cases of unpaid maternal delivery (control group). The methods of delivery were compared between the two groups, the duration of contractions at 10 minutes, 30 minutes, and 60 minutes after analgesia, and VAS when the cervix was opened to 3 cm, 8 cm, and 10 cm. Results: The proportion of vaginal delivery was significantly higher in the study group than that in the control group ( P <0.05). There was no statistically significant difference in the duration of contractions between maternal groups in the study group at 10 min, 30 min, and 60 min ( P >0.05). Secondly, the average time of analgesia in the observation group was (5.11±1.47)h. When the cervix was opened to 8cm and 10cm, the VAS score of the study group was significantly lower than that of the control group ( P <0.05). Conclusion: The application of intraspinal delivery and analgesia to VBAC can effectively improve the spontaneous vaginal delivery rate of maternal women and relieve the pain of delivery.