腰硬复合镇痛分娩联合气囊仿生助产在初产妇阴道分娩中的临床观察

Clinical observation of painless delivery with combined spinal-epidural anesthesia and balloon bionic midwifery in primipara’s vaginal

目的观察腰硬复合镇痛分娩联合气囊仿生助产在初产妇阴道分娩中的临床效果。方法将收治600例行阴道分娩的初产妇,采取随机数字法分成对照组与观察组各300例,其中对照组患者采取腰硬复合镇痛分娩,而观察组患者在腰硬复合镇痛分娩的基础上联合使用气囊仿生助产。比较两组产妇不同产程疼痛VAS评分、产程所用时长,分娩结果(无创阴道分娩、会阴裂伤/侧切后经阴道分娩、中转剖宫产),产时、产后2 h总出血量,产后尿潴留、胎儿窘迫发生率、新生儿窒息率。结果观察组初产妇不同产程疼痛VAS评分均低于对照组初产妇(P<0.001)。观察组初产妇第一、二产程及总产程时间明显短于对照组初产妇(P<0.001)。观察组初产妇无创阴道分娩率为82.33%,对照组为62.33%,观察组初产妇无创阴道分娩率高于对照组(P<0.001);观察组初产妇会阴裂伤/侧切后经阴道分娩率为10.00%,转剖宫产率为7.67%,对照组初产妇会阴裂伤/侧切后经阴道分娩率为23.33%,转剖宫产率为14.33%,观察组初产妇会阴裂伤/侧切后经阴道分娩率、转剖宫产率均低于对照组(P<0.01)。观察组初产妇产时出血量、产后2 h总出血量均少于对照组产妇(P<0.001),产后尿潴留、胎儿窘迫与新生儿窒息总发生率低于对照组产妇(P<0.01)。结论在初产妇行阴道分娩中,采取腰硬复合镇痛分娩联合气囊仿生助产技术,可明显减轻产妇在分娩生产过程中的疼痛,缩短分娩产程,增加无创阴道分娩率,减少会阴裂伤及会阴侧切率,减少产后出血量,改善分娩结局,促进自然分娩,值得临床推广应用。

Objective To observe the clinical effect of combined spinal-epidural analgesia and balloon bionic midwifery in vaginal delivery of primipara.Methods 600 primiparas who underwent vaginal delivery were randomly divided into control group and observation group,with 300 cases in each group.The control group were given combined spinal-epidural analgesia,while the observation group were given balloon bionic midwifery on the basis of combined spinal-epidural analgesia.And then,the VAS score,duration of labor,delivery outcomes(noninvasive vaginal delivery,vaginal delivery and conversion to cesarean section after perineal laceration/lateral incision)of the two groups as well as total bleeding volume during delivery and 2 h after delivery,postpartum urinary retention,fetal distress rate,and neonatal asphyxia rate were compared between the two groups.Results The VAS scores of primipara in different stages of labor in the observation group were lower than those in the control group(P<0.001).The time of the first,the second and total stages of labor in the observation group was significantly shorter than that in the control group(P<0.001).The rate of non-invasive vaginal delivery in the observation group was 82.33%,and that of the control group was 62.33%,and that of the observation group was higher than that of the control group(P<0.001).The rates of vaginal delivery and conversion to cesarean section after perineal laceration/lateral incision in the observation group were 10.00%and 7.67%,respectively,and those in the control group were 23.33%and 14.33%,respectively,the rates of vaginal delivery and conversion to cesarean section after perineal laceration/lateral incision in the observation group were lower than those in the control group(P<0.01).The amount of bleeding during delivery and 2 hours after delivery in the observation group were lower than those in the control group(P<0.001),and the total incidence of urinary retention,fetal distress and neonatal asphyxia in was lower than that in the control group(P<0.01).Conclusion In the vaginal delivery of primiparas,combined spinal-epidural analgesia and balloon bionic midwifery technology can significantly relieve the pain in the process of delivery,shorten the delivery process,increase the rate of non-invasive vaginal delivery,lower perineal laceration and lateral incision rate,reduce the amount of postpartum hemorrhage,improve delivery outcome and promote natural delivery,which is worthy of clinical application.