西藏地区无痛分娩的应用效果及临床研究

Application effect and clinical study of painless delivery in Tibet

目的为在高原地区建立无痛分娩检测体系,推广无痛分娩理念,降低剖宫产率,进行西藏地区无痛分娩的临床研究。方法通过前瞻性研究,收集2018年1月至2019年6月拉萨市人民医院150例初产妇,符合无痛分娩适应证且无禁忌证,随机数字表法分为舒芬太尼复合罗哌卡因组(A组,n=50)、芬太尼复合罗哌卡因组(B组,n=50)及未采取镇痛的对照组(C组,n=50);收集产妇分娩前后一般情况,采用视觉模拟量表(VAS)评分,观察记录分娩进程及结果,进行新生儿Apgar评分并取脐动脉血进行血气分析。结果A组和B组第一产程和第二产程均较C组时间短(P<0.05);三组间第三产程及产后出血量比较差异无统计学意义(P>0.05)。A组和B组VAS评分均低于C组(P<0.05);A组与B组差异无统计学意义(P>0.05)。三组脐动脉血pH值比较差异无统计学意义(P>0.05)。A组与B组产妇PO2均高于C组(P<0.05),A组与B组差异无统计学意义(P>0.05)。A组与B组脐动脉血PCO2均低于C组(P<0.05),A组与B组差异无统计学意义(P>0.05)。C组产妇剖宫产率高于A组和B组(P<0.05),三组新生儿在胎心异常、胎儿窘迫、新生儿窒息发生率差异无统计学意义(P>0.05),但三组产妇新生儿总体不良情况发生率差异有统计学意义(P<0.05)。A组和B组新生儿产后1 min Apgar评分高于C组新生儿(P<0.05),产后5、10 min新生儿Apgar评分三组间差异无统计学意义(P>0.05)。结论高原地区进行无痛分娩,可以减轻产妇分娩痛苦,降低剖宫产率,且安全性高,减少对母婴的不良影响,值得临床推广。

Objective In order to establish a painless delivery detection system in plateau area,promote the concept of painless delivery,reduce the cesarean section rate,the clinical study of painless childbirth in Tibet was carried out.Methods 150 primiparas in Lhasa People's Hospital from January 2018 to Juen 2019 were prospectively collected,which were randomly divided into sufentanil and ropivacaine groups(group A,n=50)and fentanyl and ropivacaine(group B,n=50)and the control group without analgesia(group C,n=50);The general conditions of the patients before and after delivery were collected.The visual analogue scale(VAS)score was used to observe and record the delivery process and results.The Apgar score of newborns was performed,and the umbilical artery blood was taken for blood gas analysis.Results The first and second stage of labor in group A and B were shorter than those in group C(P<0.05);there was no difference in the third stage of labor and postpartum bleeding between the three groups(P>0.05).The VAS scores of groups A and B were lower than that of group C(P<0.05),while there was no difference between group A and group B(P>0.05).There was no difference in pH value of umbilical artery blood between the three groups(P>0.05).The umbilical artery blood PO2 of group A and group B was higher than those of group C(P<0.05),while there was no difference between group A and group B(P>0.05).The umbilical artery blood PCO2 of group A and group B was lower than that of group C(P<0.05),while there was no difference between group A and group B(P>0.05).The cesarean section rate in group C was higher than that in groups A and B(P<0.05).There was no difference in fetal heart rate,fetal distress,and neonatal asphyxia among the three groups(P>0.05).There was significant difference in the overall incidence of adverse conditions in the three groups(P<0.05).The Apgar scores of the newborns in groups A and B were higher than those in the C group at 1 min postpartum(P<0.05),while there were no difference in the Apgar scores among the three groups at 5 and 10 min postpartum(P>0.05).Conclusions Painless delivery in plateau area can reduce the pain of delivery and the rate of cesarean section,and has high safety and reduce the adverse effects on mothers and infants,which is worthy of clinical promotion.