不同时机实施分娩镇痛对初产妇产程和分娩方式及新生儿结局的影响

Effects of labor analgesia at different time points on primiparas'stage of labor,delivery mode,and neonatal outcomes

目的探讨在不同时机实施分娩镇痛对初产妇产程、分娩方式、新生儿结局的影响。方法回顾性分析2017年1月至2020年1月期间在本院分娩的足月、单胎妊娠、自然分娩初产妇的分娩情况。依据产妇是否自愿选择分娩镇痛将其分为对照组(152例)、观察组(336例)[对照组(27.55±4.39)岁,观察组(27.46±4.26)岁];再按照分娩镇痛的不同时机将观察组分为3个亚组,其中分娩镇痛1组(112例)在宫口<3 cm时实施镇痛,分娩镇痛2组(112例)在宫口开3~4 cm时实施镇痛,分娩镇痛3组(112例)在宫口>4 cm时实施镇痛。对比不同小组实施分娩镇痛疼痛情况,各个产程时间、分娩方式及分娩结局。结果观察组在第一产程、第二产程、第三产程的视觉模拟评分法(VAS)评分均低于对照组[(3.23±0.94)分比(6.55±1.95)分,(3.44±0.85)分比(8.62±0.65)分,(3.62±0.75)分比(8.55±0.76)分],差异均有统计学意义(均P<0.05)。观察组第一产程长于对照组,第二产程短于对照组,差异均有统计学意义(均P<0.05);其中分娩镇痛1组的第一产程时间最长,而其他产程各个分娩镇痛组对比差异均无统计学意义(均P>0.05)。观察组分娩中转剖宫产率低于对照组[15.18%(51/336)比23.03%(35/152)],差异有统计学意义(P<0.05);各分娩镇痛组间中转剖宫产率对比差异均无统计学意义(均P>0.05)。观察组、对照组1 min时、5 min时新生儿Apgar评分对比差异均无统计学意义(均P>0.05)。结论实施分娩镇痛有助于缓解产妇分娩中的疼痛感,由于在宫口<3 cm前实施分娩镇痛会导致第一产程延长,而在宫口>4 cm实施镇痛又减少了有效镇痛时间,因此应选择宫口开3~4 cm时实施镇痛。同时本次研究还显示分娩镇痛有助于降低分娩中转剖宫产率,同时对新生儿结局不会产生负面影响,值得推广与应用。

Objective To explore the effects of labor analgesia at different time points on primiparas'stage of labor,delivery mode,and neonatal outcomes.Methods The delivery conditions of full-term,singleton pregnancy,and spontaneous labor primiparas who gave birth in our hospital from January 2017 to January 2020 were retrospectively analyzed.The primiparas were divided into a control group(n=152)and an observation group(n=336)according to whether they voluntarily chose labor analgesia or not.The control group was(27.55±4.39)years old,and the observation group was(27.46±4.26)years old.The observation group was subdivided into 3 subgroups according to the different timing of labor analgesia.In the analgesia group 1(n=112),the labor analgesia was given when the uterine orifice was less than 3 cm;in the analgesia group 2(n=112),the labor analgesia was given when the uterine orifice was 3 to 4 cm;in the analgesia group 3(n=112),the labor analgesia was given when the uterine orifice was>4 cm.The pain conditions,stages of labor,delivery modes,and delivery outcomes in different groups were compared.Results The Visual Analogue Scale(VAS)scores of the observation group in the first,second,and third stages of labor were lower than those of the control group[(3.23±0.94)vs.(6.55±1.95),(3.44±0.85)vs.(8.62±0.65),and(3.62±0.75)vs.(8.55±0.76)],with statistically significant differences(all P<0.05).The first stage of labor of the observation group was longer than that of the control group,and the second stage of labor was shorter than that of the control group,with statistically significant differences(both P<0.05);the first stage of labor of the analgesia group 1 was the longest,while the other stages of labor in all analgesia groups had no statistically significant differences(all P>0.05).The rate of transition to cesarean section in the observation group was lower than that in the control group[15.18%(51/336)vs.23.03%(35/152)],with a statistically significant difference(P<0.05);there were no statistically significant differences in the rate of transition to cesarean section among all analgesia groups(all P>0.05).There were no statistically significant differences in the neonatal Apgar scores at 1 min and 5 min between the observation group and the control group(both P>0.05).Conclusions The implementation of labor analgesia helps to relieve the parturient pain of during the delivery.Because the implementation of labor analgesia before the uterine orifice<3 cm leads to the prolongation of the first stage of labor,and the implementation of labor analgesia at the uterine orifice>4 cm reduces the effective analgesia time,so the labor analgesia should be implemented when the uterine orifice is 3-4 cm.At the same time,the labor analgesia can help reduce the rate of transition to cesarean section,and will not have a negative impact on neonatal outcomes,is worthy of promotion and application.