分娩潜伏期实施硬膜外镇痛分娩对母婴结局的影响

Effect of epidural analgesia during the incubation period of delivery on the outcome of maternal and infant

目的探讨分娩潜伏期实施硬膜外镇痛分娩对产妇血流动力学指标、疼痛、产程及母婴结局的影响。方法按照随机数字表法将2019年2月至2020年10月北京市怀柔区妇幼保健院收治的120例头胎足月产妇分为对照组(60例)和观察组(60例)。对照组产妇选择活跃期进行硬膜外分娩镇痛,观察组产妇选择潜伏期进行硬膜外分娩镇痛。比较两组产妇镇痛前(T0)镇痛后30min(T1)、镇痛后2h(T2)、宫口全开(T3)时血流动力学指标,给药15 min后视觉模拟疼痛量表(VAS)评分,镇痛药用量,以及产程时间和母婴结局。结果本研究中对照组和观察组分别有13、6例产妇中转进行剖宫产,中转剖宫产率分别为21.67%.(13/60).10.00%(6/60),经比较,差异无统计学意义(P>0.05),将其剔除后进行结果的数据统计分析。与T0时比,T1-T3时两组产妇收缩压(SBP)呈先降低后升高趋势,且T1时观察组显著高于对照组,T1-Ts时两组产妇舒张压(DBP)均呈先降低后升高趋势,且TI时观察组显著高于对照组,T0-T3时两组产妇心率(HR)均呈先升高后降低趋势,且T1-T3时观察组均显著低于对照组;观察组产妇VAS评分较对照组显著降低,两组产妇镇痛药用量较对照组显著升高;观察组产妇第二产程时间较对照组显著缩短(均P<0.05);两组产妇T2、T3时SBP、DBP,第一、第三产程,助产分娩率,新生儿1、5 min阿氏(Apgar)评分比较,差异均无统计学意义(均P>0.05)。结论选择潜伏期实施硬膜外镇痛分娩会增加镇痛药物的使用剂量,但可维持血流动力学稳定,对产妇镇痛效果较好,母婴安全性高。

Objective To investigate the effect of epidural analgesia during the incubation period of delivery on maternal hemodynamic indicators;pain,delivery process’maternal and infant outcome.Methods According to the random number table method,120 cases of first-born full-term women admitted to the Beijing huairou Maternal and Child Health Care Hospital from February 2019 to October 2020 were divided into the control group(60 cases)and the observation group(60 cases).The control group chosed the active period for epidural analgesia;and the observation group chosed the incubation period for epidural analgesia.The hemodynamic indexes before analgesia(T0),30 minutes after analgesia(T1),2 h after analgesia(T2);and full opening of the uterus(T3);the Visual Analog Pain Scale(VAS)score 15 min after administration;the dosage of analgesics;and the duration of labor and maternal and infant outcomes were compared between the two groups.Results In this study,there were 13 and 6 parturients who were transferred to cesarean section in the control group and observation group,respectively,the transfer rate of cesarean section were 21.67%(13/60)and 10.00%(6/60),there was no significant differences in the transfer rate of cesarean section between the two groups(P>0.05);after excluding it:statistical analysis of the results was performed.Compared with To;the systolic blood pressure(SBP)of the two groups at T1-T3 decreased firstly and then increased;and the observation group was significantly higher than the control group at Tb and the diastolic blood pressure(DBP)of the two groups at Ti~T3 both firstly decreased and then increased,,and the observation group was significantly higher than the control group at T*the heart rate(HR)of the two groups at T0-T3 increased firstly and then decreased;and the observation group was significantly lower than the control group at VAS score of the observation group was significantly lower than that of the control groups and the amount of analgesics was significantly higher than that of the control group;time of the second stage of labor of the observation group was significantly shorter than that of the control group(all P<0.05);there were no significant differences in SBP and DBP at T1 and T2;the first and third stages of labor,the rate of assisted labor;and the apgar score at 1 and 5 min between the two groups(all P>0.05).Conclusion Choosing the incubation period for epidural analgesia for delivery can increase the dosage of analgesic drugs,but it can maintain hemodynamic stability,has a better analgesic effect on the parturient and high safe for mothers and babies.