腰硬联合麻醉与硬膜外麻醉对初产妇分娩镇痛效果和产程的影响

Effects of combined spinal-epidural anesthesia and epidural anesthesia on labor analgesic effects and stages of labor of primiparas

目的研究腰硬联合麻醉与硬膜外麻醉对初产妇分娩镇痛效果和产程的影响。方法选取本院2017年7月至2018年7月收治的128例初产妇,分为对照组与研究组,各64例,对照组使用腰硬联合麻醉进行治疗,研究组使用硬膜外麻醉进行治疗,对比两组麻醉前、麻醉后各时间点(5 min、30 min、60 min、180 min、宫口全开时)视觉模拟评分(VAS),镇痛起效时间,产程时间,剖宫产率,产程时间,新生儿出生后1 min、5 min时Apgar评分,并检测不良反应的发生情况。结果麻醉后,两组VAS评分均显著下降,研究组5 min、30 min VAS评分明显低于对照组(P<0.05),而60 min、180 min和宫口全开时,两组VAS评分比较差异无统计学意义;麻醉后,研究组产妇镇痛起效时间、产程时间(第一产程、第二产程)、剖宫产率均显著低于对照组(P<0.05);两组新生儿出生后1 min、5 min Apgar评分比较差异无统计学意义;麻醉后,研究组不良反应显著低于对照组(P<0.05)。结论应用腰硬联合麻醉对初产妇分娩镇痛效果更好,能缩短产程时间,对产妇及新生儿更安全,值得推广应用。

Objective To study the effects of combined spinal-epidural anesthesia and epidural anesthesia on labor analgesic effects and stages of labor of primiparas.Methods A total of 128 primiparas treated in the hospital from July 2017 to July 2018 were selected and divided into control group and study group,with 64 cases in each group.Control group was treated with combined spinal-epidural anesthesia,and study group was given epidural anesthesia.The visual analogue score(VAS)before anesthesia and at time points after anesthesia(5 min,30 min,60 min,180 min,at full opening of uterine orifice),analgesic onset time,labor time,cesarean delivery rate,labor time and neonatal Apgar scores at 1min and 5min after delivery were compared between the two groups,and the occurrence of adverse reactions were detected.Results After anesthesia,the VAS scores in the two groups were significantly decreased,and the VAS scores in study group at 5 min and 30 min were significantly lower than those in control group(P<0.05),and there were no statistically significant differences in the VAS scores at 60 min,180 min and at full opening of uterine orifice between the two groups.After anesthesia,the analgesic onset time,labor time(first stage of labor,second stage of labor)and cesarean delivery rate in study group were significantly lower than those in control group(P<0.05).There were no statistically significant differences in the Apgar scores at 1min and 5min after delivery between the two groups.After anesthesia,the adverse reactions in study group were significantly lower than those in control group(P<0.05).Conclusion Combined spinal-epidural anesthesia has better labor analgesic effects on primiparas,and can reduce the labor time,and is safer for puerperas and neonates.Thus it is worthy of promotion and application.