低浓度局麻药椎管阻滞在潜伏期分娩镇痛中的应用

Study on the application of spinal block with low-concentration local anesthetics in labor analgesia during latent period

目的探究低浓度局麻药椎管阻滞在潜伏期分娩镇痛中的应用效果。方法选取2018年1月至2019年10月收治的初产妇120例,将所有产妇随机分为潜伏组和活跃组,每组60例。潜伏组产妇在宫口打开1~2 cm时开始分娩镇痛,活跃组产妇在宫口打开>3 cm时开始分娩镇痛。比较2组产妇产程时长、分娩方式、镇痛前后疼痛评分的变化情况、催产素使用情况以及产后出血量。比较2组新生儿体重和Apgar评分。结果潜伏组产妇的第一产程和第二产程时长均短于活跃组产妇(P<0.05)。2组产妇分娩方式差异有统计学意义(P<0.05),潜伏组产妇自然分娩率为65.00%,高于活跃组(50.00%),潜伏组产妇剖宫产率为15.00%,低于活跃组(25.00%)。2组患者分娩镇痛前疼痛评分差异无统计学意义(P>0.05)。镇痛后10 min、30 min时,潜伏组疼痛评分均低于活跃组(P<0.05)。潜伏组缩宫素使用率为20.00%,与活跃组产妇使用率比较差异无统计学意义(P>0.05)。2组产妇产后出血量比较差异无统计学意义(P>0.05)。2组新生儿体重差异无统计学意义(P>0.05),潜伏组新生儿1 min和5 min Apgar评分均高于活跃组(P<0.05)。结论在潜伏期使用低浓度局麻药椎管阻滞进行分娩镇痛可以明显缩短产程时长,缓解产痛对产妇的负面影响,有利于产妇自然分娩,减少由于疼痛导致的剖宫产,且对产后出血无明显影响,对新生儿无恶性影响,潜伏期分娩镇痛的安全性较为理想。

Objective To explore the application effects of spinal block with low-concentration local anesthetics in labor analgesia during the latent period.Methods A total of 120 primipara who were admitted into our hospital from January 2018 to October 2019 were enrolled in the study,who were randomly divided into the latent group(n=60)and the active group(n=60).The parturients in the latent group received labor analgesia when the uterine opening was 1~2cm,and the parturients in the active group received labor analgesia when the uterine opening was greater than 3cm.The duration of labor,delivery mode,changes in pain scores before and after analgesia,oxytocin use,and postpartum hemorrhage as well as the scores of neonatal weight and Apgar were observed and compared between the two groups.Results The duration of the first and the second stage of labor of parturients in latent group was significantly shorter than that in active group(P<0.05).The natural delivery rate in latent group was 65.00%,which was significantly higher than that(50.00%)in active group,and the cesarean section rate in latent group was 15.00%,which was significantly lower than that(25.00%)in active group(P<0.05).There were no significant differences in pain scores before delivery analgesia between the two groups(P>0.05).At 10min and 30min after analgesia,the pain scores in latent group were significantly lower than those in active group(P<0.05).The rate of oxytocin use in latent group was 20.00%,which was not statistically different from that in active group(P>0.05).There was no significant difference in the amount of postpartum hemorrhage between the two groups(P>0.05),nor in the weight of newborns between the two groups(P>0.05).The 1-min and 5-min Apgar scores of newborns in latent group were significantly higher than those in active group(P<0.05).Conclusion The use of spinal block with low-concentration local anesthetics for labor analgesia during the incubation period can significantly shorten the length of labor,relieve the negative effects of labor pain on the parturients,is conducive to the natural delivery of the parturient,reduce the pain caused by the cesarean section,and has no effect on postpartum hemorrhage.Obvious impact,no malignant impact on newborns,and the safety of labor analgesia during the incubation period is relatively ideal.