不同时间窗PCEA介入对高龄产妇妊娠结局影响的临床研究

Clinical Study of the Influence of PCEA at Different Time Windows on Pregnancy Outcomes of Elderly Parturient Women

目的:研究不同时间窗硬膜外自控镇痛(PCEA)介入对高龄产妇妊娠结局的影响。方法:选取2020年1月~2021年2月于某院分娩的高龄产妇60例作为研究对象,按随机数字表法分为A组和B组各30例,A组产妇于规律宫缩痛开始实施PCEA,B组于临产宫口开2cm开始实施PCEA,比较两组高龄产妇分娩疼痛程度、各产程时间、产后24h出血量、新生儿1min、5min的Apgar评分,并记录两组妊娠结局及新生儿窒息等发生情况。结果:A组第一产程潜伏期VAS评分低于B组(P<0.05),两组第一产程活跃期、产后6hVAS评分比较无显著差异(P>0.05);A组第一产程、第二产程及总产程时间短于B组(P<0.05),两组第三产程时间比较无统计学意义(P>0.05);A组产妇产时及产后24h出血量少于B组,新生儿1min、5min的Apgar评分高于B组(P<0.05);A组产妇自然分娩率高于B组,差异具有统计学意义(P<0.05),A组新生儿窒息率低于B组,但差异不具有统计学意义(P>0.05)。结论:规律宫缩痛开始实施PCEA及临产宫口开2cm开始实施PCEA均可取得较好的镇痛效果,但前者镇痛效果更为明显,且有助于缩短产程,提高自然分娩率,减少不良妊娠结局的发生,具有更好的临床推广价值。

Objective:To study the influence of patient controlled epidural analgesia(PCEA)at different time windows on pregnancy outcomes of elderly parturient women.Methods:60 elderly parturient women treated in a hospital from January 2020 to February 2021 were selected as the study subjects and divided into group A and group B according to the random number table method,with 30 cases in each group.The parturient women in group A were given PCEA at the beginning of regular contractions,while parturient women in group B were given PCEA when the opening of the uterine orifice reached 2 cm.The degree of labor pain,duration of each stage of labor,24h postpartum blood loss,neonatal Apgar scores at 1 min and 5 min after birth were compared between the two groups.Pregnancy outcomes and occurrence of neonatal asphyxia in the two groups were recorded.Results:The VAS score in incubation period of the first stage of labor of group A was lower than that of group B(P<0.05).There was no significant difference between the two groups in terms of VAS scores in active phase of the first stage of labor and at 6h after delivery(P>0.05).The duration of the first stage of labor,duration of the second stage of labor,and the total labor time of group A were shorter than those of group B(P<0.05).There was no statistically significant difference in the duration of the third stage of labor between the two groups(P>0.05).The blood loss during delivery and in 24h after delivery of group A was less than that of group B.The 1min and 5min neonatal Apgar scores were higher than those of group B(P<0.05).The rate of natural delivery in group A was higher than that in group B,and the difference was statistically significant(P<0.05).The rate of neonatal asphyxia was lower than that in group B,but the difference was not statistically significant(P>0.05).Conclusion:Both PCEA at the beginning of regular contractions and PCEA when the opening of the uterine orifice reached 2 cm can achieve good analgesic effects.However,the former can obtain more obvious analgesic effects,which is conducive to shortening the labor process,increasing the natural delivery rate,and reducing adverse pregnancy outcomes,and has better clinical promotion value.