不同分娩镇痛方式对母婴结局的影响

Effects of different labor analgesic methods on maternal and neonatal outcomes

目的比较不同的分娩镇痛方法对母婴结局的影响。方法根据纳入标准和排除标准选取2018年3月至2020年3月北京大学第三医院阴道试产的孕足月初产妇397例,根据医患共同决策分为4组:硬膜外镇痛组(镇痛组)102例、导乐陪伴组(导乐组)102例、导乐联合硬膜外镇痛组(导乐+镇痛组)91例和对照组102例,比较各组产妇的产程时间、缩宫素催产率、疼痛评分、产后出血率、中转剖宫产率等。结果镇痛组、导乐组、导乐+镇痛组在干预后30 min、1 h及2 h的VAS疼痛评分均低于对照组(P <0.05);镇痛组的第一产程和总产程时间均长于对照组、导乐组和导乐+镇痛组(P <0.05);镇痛组缩宫素催产率高于对照组、导乐组和导乐+镇痛组(P <0.05);导乐组、导乐+镇痛组中转剖宫产率均低于对照组(P <0.05)。结论导乐陪伴联合硬膜外分娩镇痛可显著减轻分娩疼痛,缩短初产妇产程,降低中转剖宫产率。

Objectives To compare the effects of different labor analgesic methods on maternal and neonatal outcomes in full-term primiparas. Methods 397 cases of fullterm primiparas admitted to Peking University Third Hospital from March 2018 to March 2020 were included and divided into the following four groups: 102 cases with epidural analgesia group(PCEA group), 102 cases with simple doula group, 91 cases with doula combined with epidural analgesia group(doula + PCEA group), and 102 cases with no labor analgesia group(control group). The visual analogue scale(VAS) pain score, duration of labor,oxytocin use rate, mode of deliveries, postpartum hemorrhage and ratio of tran fer cesarean section were recorded. Results The VAS pain score of women in PCEA group, doula group, doula + PCEA group at 30 min, 1 h and 2 h after intervention were all lower than those of control group(P < 0.05). The first stage of labor and the transfer cesarean section total stage of labor in the analgesia group were longer than those in the control group, doula group, doula +PCEA(P < 0.05). Oxytocin use rate in the PCEA group was significantly increased compared to the control group, doula group and doula + analgesia group(P < 0.05). The ratio of transfer cesarean section is significantly reduced in the doula group and the doula + PCEA group in comparison with the control group(P < 0.05). Conclusions Doula combined with epidural analgesia was an effective method of labor analgesia in shortening labor stage, reducing the ratio of transfer cesarean section.