连续硬膜外阻滞分娩镇痛对分娩及新生儿结局的影响

Effect of continuous epidural block on delivery and neonatal outcome

目的探讨连续硬膜外阻滞分娩镇痛对分娩及新生儿结局的影响。方法回顾性分析2014年10月至2015年4月在安徽省妇幼保健院住院分娩的202例自然临产孕妇的临床资料。首先按分娩次数分为初产妇(105例)和经产妇(97例);再按是否行分娩镇痛,分别分为镇痛组和非镇痛组,对各组的分娩和新生儿情况进行分析。结果初产妇镇痛组第一产程及第二产程时间长于非镇痛组,差异均有统计学意义(均P<0.05)。经产妇镇痛组第一产程时间长于非镇痛组,差异有统计学意义(P<0.05);而第二产程时间2组差异无统计学意义(P>0.05)。初产妇镇痛组催产素使用比例高于非镇痛组,剖宫产比例低于非镇痛组[29.8%(17/57)比12.5%(6/48)、3.5%(2/57)比18.6%(9/48)],差异均有统计学意义(均P<0.05)。无论是初产妇还是经产妇,镇痛组与非镇痛组产后出血量、新生儿体质量、胎儿窘迫和新生儿肺炎发生率差异均无统计学意义(均P>0.05)。对于初产妇,分娩镇痛是剖宫产的一个保护性因素(比值比=0.17,95%置信区间:0.03~0.81,P=0.01)。结论分娩镇痛对母婴是安全的。

Objective To investigate the effect of continuous epidural block on delivery and neonatal outcome.Methods Clinical data of 202 cases of spontaneous labor in Anhui Women and Child Health Care Hospital from October 2014 to April 2015 were retrospectively analyzed,including 105 primiparas and 97 multiparas.According to whether labor analgesia was performed,the patients were divided into analgesia group and non-analgesia group.Delivery and neonatal outcomes were analyzed.Results The first and second stages of labor in primipara analgesia group were longer than those in non-analgesia group(both P<0.05).In multiparas there was a longer first stage of labor in analgesia group(P<0.05)but no statistical difference was noticed in the second stage of labor(P>0.05).Primipara analgesia group had a higher use rate of oxytocin and a lower rate of cesarean section compared with non-analgesia group[29.8%(17/57)vs 12.5%(6/48),3.5%(2/57)vs 18.6%(9/48)](both P<0.05).In both primiparas and multiparas there were no statistical differences in postpartum hemorrhage,neonatal weight,fetal distress and neonatal pneumonia between analgesia and non-analgesia groups(all P>0.05).Epidural analgesia was a protective factor of cesarean section for primiparas(odds ratio=0.17,95%confidence interval:0.03-0.81,P=0.01).Conclusion Labor analgesia with continuous epidural block is safe for mothers and infants.