低浓度局部麻醉药物分娩镇痛对第二产程可疑型电子胎心监护的母儿结局的影响--基于倾向性评分匹配的病例对照研究

Effect of low-dose epidural analgesia on maternal and fetal outcomes of women with nonreassuring fetal heart rate tracing in the second stage of labor:a case-control study based on propensity score-matched analysis

目的研究低浓度局部麻醉药物分娩镇痛在第二产程出现可疑型电子胎心监护(EFM)时对母儿近期结局的影响。方法选择定期产检、单胎头位足月分娩且第二产程出现可疑型EFM的1179例产妇为研究对象,通过倾向性评分匹配选取使用分娩镇痛的232例产妇为镇痛组,未使用分娩镇痛的232例产妇为非镇痛组,比较2组产妇及新生儿近期结局。结果镇痛组中产妇的产钳助产率为51.3%,新生儿住院率为13.8%,新生儿轻度酸血症发生率为53.4%,均高于非镇痛组,且住院时间也比非镇痛组延长(P均<0.05)。2组间会阴侧切率、产后出血量、严重会阴裂伤、会阴伤口愈合不良、羊水污染及新生儿窒息、新生儿重度酸血症、新生儿肺炎、呼吸窘迫综合征、缺血缺氧性脑病发生率比较差异均无统计学意义(P>0.05),2组新生儿ICU入住率比较差异亦无统计学意义(P>0.05)。第二产程可疑型EFM的类型包括频发早期减速、频发变异减速、持续胎心过速和延长减速,在镇痛组及非镇痛组的分布比较差异无统计学意义(P>0.05)。Logistic回归分析显示分娩镇痛增加产钳助产及新生儿轻度酸血症的风险(OR分别为2.412、1.733,P均<0.05),但不增加新生儿窒息发生的风险(P>0.05)。结论低浓度局部麻醉药物分娩镇痛第二产程出现可疑型EFM时需对产妇积极处理,低浓度局部麻醉药物分娩镇痛不会增加母亲及新生儿的严重不良结局。

Objective To evaluate the effect of epidural analgesia using low-concentration local anesthetics on the short-term maternal and fetal outcomes of the women with nonreassuring fetal heart rate tracing in the second stage of labor.Methods 1179 pregnant women who had regular prenatal visit were recruited into the study.All participants were singleton term vaginal deliveries with cephalic presentation and had nonreassuring fetal heart rate tracing during the second stage of labor.After propensity score-matched analysis,232 subjects with epidural analgesia were allocated into the analgesia group and 232 cases without epidural analgesia during labor were assigned into the non-analgesia group.The short-term maternal and fetal outcomes were statistically compared between two groups.Results In the analgesia group,the incidence rates of forceps delivery,neonatal admission and umbilical cord blood pH<7.2 were 51.3%,13.8%and 53.4%,respectively,and the length of maternal hospitalization stay was 3.40 d,which were all significantly higher than those in the non-analgesia group(all P<0.05).However,the episiotomy rate,postpartum hemorrhage,severe perineal laceration,poor perineal wound healing,meconium-stained amniotic fluid,neonatal asphyxia,neonatal umbilical cord blood pH<7.0 and neonatal morbidities including pneumonia,respiratory distress syndrome and hypoxic ischemic encephalopathy did not significantly differ between two groups(all P>0.05).The neonatal intensive care unit(ICU)admission rate also did not significantly differ between two groups(P>0.05).The distributions of four types of nonreassuring fetal heart rate tracing in the second stage of labor including recurrent early deceleration,recurrent variable deceleration,tachycardia and prolonged deceleration did not significantly differ between two groups(all P>0.05).Logistic regression analysis showed that epidural analgesia significantly increased the risk of forceps delivery and neonatal umbilical blood pH<7.2 in pregnant women with nonreassuring fetal heart rate tracing during the second stage of labor(OR=2.412 and 1.733,both P<0.05),whereas did not increase the risk of neonatal asphyxia(P>0.05).Conclusion Epidural analgesia does not increase the risk of severe maternal and neonatal outcomes if active managements are implemented when nonreassuring fetal heart rate tracing occurs in the second stage of labor.