全产程腰硬联合阻滞分娩镇痛联合气囊仿生助产在瘢痕子宫妊娠阴道试产中的应用

Application of Full-duration Spinal-epidural Anesthesia Combined with Labor Analgesia Combined with Balloon Bionic Midwifery in Vaginal Delivery of Scar Uterine Pregnancy

目的探讨全产程腰硬联合阻滞分娩镇痛联合气囊仿生助产在瘢痕子宫妊娠阴道试产中应用的可行性及安全性。方法随机选取该院2018年9月—2019年9月收治的150名符合阴道试产的瘢痕子宫妊娠孕妇,随机平均分成3组,A组采用腰硬联合阻滞分娩镇痛加气囊仿生助产;B组采用腰硬联合阻滞分娩镇痛;C组采用气囊仿生助产。结果A组总产程为(483.2±97.9)min,B组为(684.5±102.7)min,C组为(692.6±101.2)min,A组的总产程明显小于B组与C组(t=24.080、24.560,P=0.000、0.000);A组的产后出血量为(343.2±42.8)mL,B组为(386.1±52.3)mL,C组为(385.4±54.7)mL,A组的产后出血量小于B组与C组,(t=35.900、34.940,P=0.000、0.000);A组宫口开1 cm、5 cm和全开时的VAS评分分别为(2.2±0.7)分、(3.9±0.6)分、(4.2±0.6)分,B组分别为(2.5±0.6)分、(3.8±0.7)分、(4.5±0.7)分,C组分别为(8.7±0.7)分、(7.9±0.5)分、(9.2±0.3)分,宫口开1 cm时(t=1.940、47.550,P=0.050、0.000),宫口开5 cm(t=0.760、33.700,P=0.440、0.000),全开时(t=1.870、43.630,P=0.050、0.000),3组宫口开1 cm、5 cm和全开时疼痛评分比较,A组与B组对比差异无统计学意义(P>0.05),A组和B组均低于C组,差异有统计学意义(P<0.05)。结论在瘢痕子宫妊娠阴道试产中选用全称腰硬联合阻滞分娩镇痛联合气囊仿生助产方式相较于另外两种方式,总产程短,产后出血量少,整个产程疼痛评分低。

Objective To explore the feasibility and safety of full-course lumbar epidural combined with block analgesia combined with balloon biomimetic midwifery in the trial of vaginal pregnancy in scar uterine pregnancy.Methods From September 2018 to September 2019,random selection 150 cases of pregnant admission women with uterine scars who were eligible for vaginal trials were randomly divided into three groups at random.Group A used lumbar-scleral combined block analgesia plus balloon biomimetic midwifery;Group B used combined spinal and epidural analgesia for delivery and analgesia;Group C used bladder to assist labor.Results The total delivery time of group A was(483.2±97.9)min,that of group B was(684.5±102.7)min,and that of group C was(692.6±101.2)min.The total delivery time of group A was significantly smaller than that of groups B and C(t=24.080,24.560,P=0.000,0.000);postpartum hemorrhage in group A was(343.2±42.8)mL,(386.1±52.3)mL in group B(385.4±54.7)mL in group C,and postpartum hemorrhage in group A was less than Groups B and C(t=35.900,34.940,P=0.000,0.000);VAS scores of group A with 1 cm,5 cm and full opening were(2.2±0.7)points,(3.9±0.6)points,(4.2±0.6)points,group B were(2.5±0.6)points,(3.8±0.7)points,(4.5±0.7)points,and group C were(8.7±0.7)points,(7.9±0.5)points.(9.2±0.3)points,when the mouth is opened 1 cm(t=1.940,47.550,P=0.050,0.0000),the mouth is opened 5 cm(t=0.760,33.700,P=0.440,0.000),when fully opened(t=1.870,43.630,P=0.050,0.000),the three groups of uterine opening 1 cm,5 cm and pain scores when compared,there was no statistically significant difference between group A and group B(P>0.05),group A and group B were lower than group C,the difference was statistically significant(P<0.05).Conclusion Compared with the other two methods,the full-length lumbar epidural combined with analgesia and childbirth combined with balloon biomimetic midwifery is used in the trial of vaginal pregnancy in scar uterine pregnancy.