潜伏期硬膜外分娩镇痛用于瘢痕子宫再次妊娠产妇的效果

Efficacy of epidural labor analgesia in latent phase for re-pregnant parturients with scar uterus

目的评价潜伏期硬膜外分娩镇痛用于瘢痕子宫再次妊娠产妇的效果。方法单胎、足月、头位的瘢痕子宫再次妊娠产妇100例,年龄26~38岁,身高158~170 cm,体重61~95 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=50):活跃期硬膜外分娩镇痛组(A组)和潜伏期硬膜外分娩镇痛组(B组)。A组第一产程活跃期(宫口≥3 cm)开始实施硬膜外分娩镇痛,B组第一产程潜伏期(宫口开至1 cm)即实施硬膜外分娩镇痛。镇痛泵配方:0.1%罗哌卡因+舒芬太尼0.5μg/ml的混合液共100 ml,背景输注剂量8 ml/h,PCA剂量5 ml,锁定时间15 min,胎儿娩出后关闭镇痛泵。分别于入临产室后、宫口开至1、2、3、4 cm、宫口开全和胎儿娩出即刻,记录VAS评分;记录产程时间、产后出血量、剖宫产情况和转剖宫产至胎儿娩出时间间隔;记录新生儿出生后1 min时的Apgar评分及脐带血血气分析结果。结果与A组比较,B组产妇潜伏期各时点VAS评分降低,第一产程时间延长,剖宫产率降低,转剖宫产至胎儿娩出时间间隔缩短(P<0.05),产后出血量差异无统计学意义(P>0.05)。2组新生儿Apgar评分和脐带血血气结果比较差异无统计学意义(P>0.05)。结论潜伏期硬膜外分娩镇痛用于瘢痕子宫再次妊娠产妇的效果优于活跃期硬膜外分娩镇痛。

Objective To evaluate the efficacy of epidural labor analgesia in the latent phase for the re-pregnant parturients with scar uterus.Methods One hundred re-pregnant parturients with scar uterus who were at full-term with a singleton fetus in vertex presentation,aged 26-38 yr,with height between 158-170 cm,weighing 61-95 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,were divided into 2 groups(n=50 each)using a random number table method:epidural labor analgesia in active phase group(group A)and epidural labor analgesia in latent phase group(group B).Epidural labor analgesia was performed in active phase of labor(cervical dilatation≥3 cm)in group A and in latent phase of labor(cervical dilatation≥1 cm)in group B.Epidural labor analgesia solution contained the mixture(100 ml)of 0.1%ropivacaine and sufentanil 0.5μg/ml,and the analgesia pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion 8 ml/h and then turned off after delivery of fetus.Visual analogue scale scores were recorded on admission to the labor room,when the cervical dilation was 1,2,3,4 and 10 cm and at the time point immediately after delivery.The labor time,volume of postpartum hemorrhage,emergency cesarean section,decision-to-delivery interval,Apgar score of the newborn at 1 min after birth and results of umbilical cord blood gas analysis were recorded.Results Compared with group A,the visual analogue scale scores in latent phases of labor were significantly decreased at each time point of latent phases,the duration of the first stage of labor was prolonged,the rate of emergency cesarean section was decreased,and the decision-to-delivery interval was shortened(P<0.05),and no significant change was found in the volume of postpartum hemorrhage in group B(P>0.05).There was no significant difference in the Apgar score of the newborn and results of umbilical cord blood gas analysis between two groups(P>0.05).Conclusion Epidural labor analgesia performed in the latent phase provides better efficacy than that performed in the active phase when used for the re-pregnant parturients with scar uterus.