硬膜外分娩镇痛对产妇产后早期痛觉过敏的影响

Effect of epidural labor analgesia on hyperalgesia in early postpartum period

目的评价硬膜外分娩镇痛对产妇产后早期痛觉过敏的影响。方法选取待产妇90例,年龄20~35岁,ASA分级Ⅰ或Ⅱ级,初次妊娠,单胎足月,孕38~41周,根据是否选择分娩镇痛将其分为2组:分娩镇痛组(LA组,n=38)和常规分娩组(L组,n=52)。LA组待宫口开至3~4 cm时行硬膜外分娩镇痛。于入产房时、产后1、2及3 d时测定机械痛阈。于宫口开至3 cm(T1)、宫口开全(T2)、产后12 h(T3)、产后24 h(T4)及产后48 h(T5)时进行VAS评分。记录第一产程及第二产程时长、产后2 h宫内出血量。记录新生儿出生后1、5及10 min时Apger评分。结果最终L组完成51例,LA组完成37例。与L组比较,LA组产后机械痛阈升高,T2-4时VAS评分降低,第一产程及第二产程延长(P<0.05),产后2 h宫内出血量和新生儿Apgar评分差异无统计学意义(P>0.05)。结论硬膜外分娩镇痛可减轻产妇产后早期痛觉过敏。

Objective To evaluate the effect of epidural labor analgesia on hyperalgesia in the early postpartum period.Methods Ninety nulliparas of primigravid,of American Society of Anesthesiologists physical statusⅠorⅡ,aged 20-35 yr,who were at full term with a singleton fetus,at 38-41 weeks of gestation,were assigned to labor analgesia group(group LA,n=38)and labor group(group L,n=52)according to whether the patient requested epidural labor analgesia or not.Epidural labor analgesia was performed when the cervical dilatation was 3-4 cm in LA group.The mechanical pain threshold was measured on admission to the delivery room and at days 1,2 and 3 after delivery.Visual analog scale scores were assessed and recorded when cervical dilatation was 3 cm(T1),at complete cervical dilatation(T2),and at 12,24 and 48 h after delivery(T3-5).The duration of the first and second stage of labor and amount of intrauterine bleeding 2 h after delivery were recorded.Apger scores at 1,5 and 10 min after birth were recorded.Results Fifty-one cases completed surgery in group L and 37 cases in group LA.Compared with group L,the mechanical pain threshold was significantly increased,and visual analog scale score at T2-4 was decreased,the first and second stages of labor were prolonged(P<0.05),and no statistically significant change was found in intrauterine bleeding volume or Apgar score at 2 h after delivery in group LA(P>0.05).Conclusion Epidural labor analgesia can reduce hyperalgesia in the early postpartum period.