剖宫产术后再次妊娠阴道试产应用椎管内麻醉镇痛的临床研究与分析

Clinical research and analysis of intra-spinal anesthesia and analgesia for vaginal trial delivery after cesarean section

目的探究椎管内麻醉镇痛在剖宫产术后再次妊娠阴道试产中的应用效果。方法选择阳江市阳东区妇幼保健院2019年8月—2020年12月收治的156例剖宫产术后再次妊娠阴道试产孕妇,采用随机信封法分为镇痛组(n=78)与非镇痛组(n=78)。镇痛组宫口开2~3 cm实施椎管内麻醉,非镇痛组未实施任何药物或器械进行分娩镇痛。比较两组临产方式,产程进展情况,产后出血,产后尿潴留,新生儿Apgar评分,NICU入住率,宫口开大至5、8、10 cm时视觉模拟评分法(VAS)评分。结果两组产程进展情况、产后出血、产后尿潴留、新生儿Apgar评分(出生1、5 min时)、NICU入住率比较,差异无统计学意义(P>0.05)。两组新生儿出生5 min时Apgar评分高于1 min时,差异有统计学意义(P<0.05)。镇痛组宫口开大至5、8、10 cm时VAS评分均低于非镇痛组,差异有统计学意义(P<0.05);非镇痛组宫口开大至10 cm时VAS评分高于宫口开大至5与8 cm,宫口开大至8 cm时VAS评分高于5 cm,差异有统计学意义(P<0.05);镇痛组宫口开大至10 cm时VAS评分高于5与8 cm,差异有统计学意义(P<0.05);镇痛组宫口开大至8 cm与5 cm时VAS评分比较,差异无统计学意义(P>0.05)。结论剖宫产术后再次妊娠阴道试产中应用椎管内麻醉镇痛安全可行,可显著降低分娩疼痛度,值得应用与推广。

Objective To explore the application effect of intra-spinal anesthesia and analgesia in vaginal trial delivery after cesarean section.Methods A total of 156 pregnant women undergoing vaginal trial delivery after cesarean section in Maternity and Child Health Hospital of Yangdong District in Yangjiang City from August 2019 to December 2020 were selected and divided into analgesia group(n=78)and non-analgesia group(n=78)by random envelope method.In the analgesic group,intra-spinal anesthesia was performed at 2 to 3 cm from the uterine orifice,and the non-analgesic group was not given any drugs or equipment for labor analgesia.The labor methods,labor progress,postpartum hemorrhage,and postpartum urinary retention,neonatal Apgar scores,NICU occupancy rate,and visual analogue scale(VAS)score when the uterine opening reached 5,8,10 cm were compared between the two groups.Results There were no significant differences in the progress of labor,postpartum hemorrhage,postpartum urinary retention,newborn Apgar scores(at 1,5 minutes of birth),and NICU occupancy rate between the two groups(P>0.05).The Apgar scores of newborns in the two groups at 5 minutes of birth were higher than those at 1 minute of birth,the differences were statistically significant(P<0.05).The VAS scores of the analgesia group were lower than those of the non-analgesia group when the uterine opening was 5,8,and 10 cm,and the differences were statistically significant(P<0.05).The VAS score of the non-analgesic group when the uterine opening was 10 cm was higher than that at 8 cm and 5 cm,and the VAS score was higher than that at 5 cm when the uterine opening was 8 cm,the differences were statistically significant(P<0.05).The VAS score of the analgesia group was higher than that at 5 and 8 cm when the uterine orifice opened to 10 cm,the difference was statistically significant(P<0.05).There was no statistically significant difference in the VAS score when the uterine opening was 8 cm and 5 cm in the analgesia group(P>0.05).Conclusion It is safe and feasible to apply intra-spinal anesthesia in vaginal trial delivery after cesarean section.It can significantly reduce the pain of labor and is worthy of application and promotion.