诊断模型联合分娩镇痛预防剖宫产术后经阴道分娩疼痛的影响

Effect of Groman model along with labor analgesia on pain relief during vaginal birth after cesarean section

目的研究Grobman模型联合分娩镇痛对剖宫产术后经阴道分娩预防分娩疼痛及母婴结局影响。方法收集2016年10月至2018年9月南通市妇幼保健院收治的瘢痕子宫再次妊娠阴道分娩产妇180例。根据随机数字法,分为观察组(90例)和对照组(90例),观察组运用Grobman模型评估,对阈值>70%的瘢痕子宫阴道分娩产妇,给予椎管内镇痛,阈值≤70%者于宫口扩张>3 cm时给予椎管内镇痛,对照组为自然临产。统计分析两组产妇第一与第二产程时长、出血量、先兆子宫破裂发生率、疼痛感评分、平均住院时间和新生儿窒息率、新生儿Apgar评分。结果观察组产妇的VAS评分(1.43±0.52)分、住院时间(5.13±0.25)d,低于对照组的(6.39±1.82)分、(7.62±0.48)d,差异有统计学意义(t=24.860、43.678,P<0.05);观察组的阴道分娩率94.44%,高于对照组的81.11%,差异有统计学意义(χ^(2)=7.457,P<0.05)。观察组的剖宫产率5.56%,低于对照组的18.89%,差异有统计学意义(χ^(2)=9.015,P<0.05);观察组的总满意率97.78%,高于对照组的87.78%,差异有统计学意义(χ^(2)=6.716,P<0.05)。结论 Grobman模型联合分娩镇痛应用于剖宫产术后经阴道分娩,能有效减轻疼痛感,不延长产程,对新生儿无不良影响,安全有效。

Objective To explore the effects of Groman model along with labor analgesia on pain relief as well as on maternal and neonatal outcomes during vaginal birth after cesarean section. Methods A total of 180 multipara undergoing vaginal birth after cesarean section in Nantong Maternal and Child Health Hospital from October 2016 to September 2018 were enrolled and evenly divided into observation group(n=90) and control group(n=90) using random number table method.Subjects in the observation group was evaluated by Groman model and those with a pain threshold greater than 70% were given intrathecal analgesia, while subjects in the control group underwnt natural childbirth.The length of the first and second stage of labor, postpartum bleeding, incidence of uterine rupture, pain score, length of hospital stay, neonatal asphyxia rate and neonatal Apgar score were compared between the two groups. Results In the observation group, the visual analogue score(VAS) was remarkably lower than that in the control group(1.43±0.52 vs 6.39±1.82, t=24.860, P<0.05) and the length of hospital stay was much shorter(5.13±0.25 d vs 7.62±0.48 d, t=43.678, P<0.05).The rate of vaginal childbirth and the overall satisfaction rate were both significantly higher in the observation group than those in the control group(94.44% vs 81.11%, 97.78% vs 87.78%, χ^(2)=7.457,6.716,P<0.05), while the rate of cesarean section was significantly lower(5.56% vs 18.89%,χ^(2)=9.015,P<0.05). Conclusions Groman model along with labor analgesia can effectively reduce labor pain during vaginal birth after cesarean section without extending labor duration and is safe for both multipara and newborns.