硬膜外分娩镇痛对初产妇产后早期盆底功能的影响

Impact of epidural analgesia during delivery on pelvic floor function on primipara in early postpartum period

目的采用经会阴三维盆底超声观察给予初产妇硬膜外分娩镇痛对产后早期盆底功能的影响。方法选取136例初产妇,根据其初产时接受硬膜外镇痛情况分为潜伏期镇痛组(n=38)、活跃期镇痛组(n=33)和未镇痛组(n=65);对比静息状态及最大瓦尔萨尔瓦动作下3组产妇超声参数,观察硬膜外镇痛对其盆底功能的影响。结果潜伏期镇痛组及活跃期镇痛组产后膀胱膨出发生率、膀胱颈移动度、最大瓦尔萨尔瓦动作下肛提肌裂孔面积及肛提肌裂孔扩张率均小于非镇痛组(P均<0.05),且潜伏期镇痛组静息状态下肛提肌裂孔面积大于非镇痛组(P<0.05)。潜伏期镇痛组肛提肌裂孔扩张率小于活跃期镇痛组(P<0.05)。结论于分娩时,特别是分娩潜伏期给予初产妇硬膜外镇痛可在一定程度上保护产后早期盆底功能。

Objective To observe the impact of epidural analgesia during the first delivery on pelvic floor function of primipara in early postpartum period. Methods A total of 136 primiparas were selected and divided into incubation analgesia group(n=38), active analgesia group(n=33) and non-analgesia group(n=65) according to the condition of epidural analgesia during the first delivery. The pelvic floor parameters of primiparas at resting-state and under the maximum Valsalva maneuver were compared among 3 groups, and the impacts of epidural analgesia on pelvic floor function were observed. Results The incidence of cystocele, bladder neck movement degree, the area of hiatus of levator ani muscle under the maximum Valsalva maneuver and the dilation rate of hiatus of levator ani muscle of primiparas in incubation analgesia group and active analgesia group were lower than those in non-analgesia group(all P<0.05), and the area of hiatus of levator ani muscle at resting-state in incubation analgesia group was greater than that in non-analgesia group(P<0.05). The dilation rate of hiatus of levator ani muscle in incubation analgesia group was lower than that in active analgesia group(P<0.05). Conclusion Epidural analgesia during the first delivery, especially in the incubation period, could protect pelvic floor function of primiparas in a certain extent in early postpartum period.