全程硬膜外分娩镇痛在瘢痕子宫再次妊娠阴道试产中的应用

Application of Whole Course Labor Analgesia in Vaginal Delivery of Second Pregnancy with Scar Uterus

目的评价全程硬膜外分娩镇痛在剖宫产术后再次妊娠阴道试产中的应用效果,为提高阴道试产成功率提供参考依据。方法选择2019年2月1日-2020年12月1日某院收治的102例瘢痕子宫再次妊娠拟行阴道分娩者,采用随机数字表法将产妇分为2组,全程镇痛组(51例)和活跃期镇痛组(51例)。比较两组宫口开全时间、产程时间、缩宫素应用率、疼痛程度、应激反应指标和妊娠结局的差异。结果全程镇痛组宫口开全时间、各产程时间、缩宫素应用率均低于活跃期镇痛组(P<0.05),T_(3),T_(4)时VAS评分均低于活跃期镇痛组(P<0.05),T_(3)、T_(4)、分娩后(M_(1))Cor、E、NE水平均低于活跃期镇痛组(P<0.05),剖宫产率低于活跃期镇痛组(P<0.05)。2组并发症发生率比较无统计学差异(P>0.05)。结论全程硬膜外分娩镇痛可降低阴道试产中产妇应激反应,减轻疼痛程度,缩短产程,提高阴道试产成功率,较活跃期镇痛更适合瘢痕子宫再次妊娠阴道分娩镇痛。

Objectives To evaluate the application effect of whole epidural analgesia in vaginal trial labor of second pregnancy after cesarean section,and to provide reference for improving the success rate of vaginal trial labor.Methods From February 1st,2019 to December 1st,2020 in a hospital,102 cases of re-pregnancy with scar uterus were selected and divided into two groups by random number table method:full analgesia group(51 cases)and active analgesia group(51 cases).The total time of uterine opening,labor time,oxytocin application rate,pain degree,stress response index and pregnancy outcome were compared between the two groups.Results The total time of uterine opening,the time of labor and the application rate of oxytocin in the whole analgesia group were lower than those in the active analgesia group(P<0.05),the SCORES of T3 and T4VAS were lower than those in the active analgesia group(P<0.05),the levels of Cor,E and NE in T3,T4 and after delivery(M1)were lower than those in the active analgesia group(P<0.05).The rate of cesarean section was lower than that of active analgesia group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions The whole course labor analgesia could reduce the stress response,reduce the intensity of labor pain,shorten the labor process,improve the success rate of vaginal trial labor,and is more suitable for vaginal delivery analgesia of second pregnancy with scar uterus.