硬膜外镇痛下非自发性阴道分娩的风险因子分析

Risk Factor Analysis of Spontaneous Vaginal Delivery under Epidural Analgesia

目的:探讨非自发性阴道分娩的风险因子。方法:以内黄县人民医院2018年2月—2019年5月经硬膜外镇痛(EA)后阴道分娩的350例产妇作为研究对象进行回顾性分析,根据是否为自发性阴道分娩分为自发性分娩组(n=232)和非自发性分娩组(n=118),比较两组患者EA持续时间、产妇年龄、孕周、产次、新生儿体重以及是否使用催产素等临床资料,分析影响EA下非自发性阴道分娩的风险因子。结果:单因素分析显示,与自发性分娩组患者相比,非自发性分娩组患者EA持续时间延长,产妇年龄增高,初产妇、使用催产素产妇人数增加,差异均有统计学意义(P<0.05)。二元logistic回归分析显示,产妇年龄、EA持续时间以及使用催产素是影响非自发性阴道分娩的独立危险因素。初产和经产进行分组分析显示,EA时间是初产妇和经产妇非自发性阴道分娩的共有独立危险因素(P<0.05),而产妇年龄和催产素的应用仅对初产妇非自发性阴道分娩有影响(P<0.05)。结论:EA持续时间延长与产妇非自发性阴道分娩有关,催产素的应用以及高龄会增加初产妇长时间EA非自发性阴道分娩的风险。

Objective:To explore the risk factors of non-spontaneous vaginal delivery.Methods:350 parturients who gave birth to vagina after menstrual epidural analgesia(EA)in the hospital from February 2018 to May 2019 were taken as the research objects for retrospective analysis.According to whether it was a spontaneous vaginal delivery,it was divided into spontaneous delivery group(n=232)and non-spontaneous delivery group(n=118).The clinical data of the two groups of patients,such as the duration of EA,maternal age,gestational age,parity,newborn weight,and whether to use oxytocin were compared,and the risk factors affecting non-spontaneous vaginal delivery under EA were analyzed.Results:Univariate analysis showed that,compared with the spontaneous delivery group,the EA duration of the non-spontaneous delivery group was longer,the maternal age was higher,and the number of primipara and oxytocin-using mothers increased,with statistically significant differences(P<0.05).Binary logistic regression analysis showed that maternal age,EA duration,and oxytocin use were independent risk factors for nonspontaneous vaginal delivery.A subgroup analysis of first and perinatal delivery showed that EA time was a common independent risk factor for nonspontaneous vaginal delivery in primipara and perinatal mothers(P<0.05),while maternal age and oxytocin use only had an effect on nonspontaneous vaginal delivery in puerpera(P<0.05).Conclusion:Prolonged EA duration is associated with nonspontaneous vaginal delivery,and the use of oxytocin and advanced age increase the risk of prolonged EA nonspontaneous vaginal delivery in primipara.