椎管内分娩镇痛对产程及母婴结局的影响

The effect of intraspinal labor analgesia inlabor progress,maternal and infant outcomes

目的探讨椎管内分娩镇痛对产程及母婴结局的影响。方法选取2019年3月至2020年3月汕头大学医学院第二附属医院收治的200例足月单胎头位初产妇作为研究对象,按随机数字表法分为对照组(100例,自然分娩)和镇痛组(100例,镇痛分娩),比较两组产妇分娩疼痛情况和产程进展、分娩结局。结果镇痛组在镇痛10、30和60 min时视觉模拟量表(VAS)评分低于对照组[(1.30 ± 0.17)分比(9.50 ± 0.53)分、(0.50 ± 0.22)分比(9.50 ± 0.16)分、(0.40 ± 0.28)分比(9.50 ± 0.34)分],差异有统计学意义(P<0.05)。镇痛组第一产程时间较对照组延长 [(347.6 ± 54.4) min比(325.8 ± 58.5) min],活跃期、第二产程、第三产程和总产程时间均低于对照组[(184.3 ± 39.5) min比(202.9 ± 42.7) min、(57.8 ± 17.9) min比(85.3 ± 16.9)min、(7.7 ± 5.0) min比(16.3 ± 5.2) min、(503.6 ± 131.4) min比(596.5 ± 175.7) min],差异有统计学意义(P<0.05)。镇痛组产后2 h和24 h出血量低于对照组[(223.64 ± 80.34) ml比(276.97 ± 82.35)ml、(331.57 ± 92.47) ml比(384.59 ± 94.25)ml],差异有统计学意义(P<0.05)。镇痛组顺产率和缩宫素使用率高于对照组[91.0%(91/100)比75.0%(75/100)、83.0%(83/100)比49.0%(49/100)],差异有统计学意义(P<0.05);镇痛组新生儿Apgar评分中的肌张力、脉搏、反射性反应、呼吸作用评分和总评分高于对照组(P<0.05);镇痛组新生儿窘迫发生率低于对照组[4.0%(4/100)比15.0%(15/100)],差异有统计学意义(P<0.05)。结论椎管内分娩镇痛可缩短产程时间,减少产后出血量,改善新生儿Apgar评分,提高顺产率,改善母婴结局。

Objective To explore the effect of intraspinal labor analgesia on labor progress,maternal and infant outcomes.Methods Two hundred cases of full-term singleton primiparous women in head position admitted to the Second Affiliated Hospital of Shantou University Medical College from March 2019 to March 2020 were selected as the research subjects.According to the random number table method,they were divided into the control group(100 cases,natural delivery)and the analgesia group(100 cases,analgesia delivery).The visual analoguescore(VAS),progress of labor,and the outcome of delivery between the two groups werecompared.Results The VAS scores of the analgesic group at 10,30 and 60 min after analgesia were lower than those in the control group:(1.30±0.17)scores vs.(9.50±0.53)scores,(0.50±0.22)scores vs.(9.50±0.16)scores,(0.40±0.28)scores vs.(9.50±0.34)scores,the differences were statistically significant(P<0.05).The first stage of labor in the analgesia group was longer than that in the control group:(347.6±54.4)min vs.(325.8±58.5)min;but the active stage,the second stage of labor,the third stage of labor and the total duration of labor in the analgesia group were shorter than those in the control group:(184.3±39.5)min vs.(202.9±42.7)min,(57.8±17.9)min vs.(85.3±16.9)min,(7.7±5.0)min vs.(16.3±5.2)min,(503.6±131.4)min vs.(596.5±175.7)min,the differences were statistically significant(P<0.05).The 2 h and 24 h postpartum hemorrhage in the analgesia group were significantly lower than those in the control group:(223.64±80.34)ml vs.(276.97±82.35)ml,(331.57±92.47)ml vs.(384.59±94.25)ml,the differences were statistically significant(P<0.05).The rate of normal delivery and the use of oxytocin in the analgesia group were higher than those in the control group:91.0%(91/100)vs.75.0%(75/100),83.0%(83/100)vs.49.0%(49/100),the differences were statistically significant(P<0.05).In the newborn Apgar scores,the muscle tension,pulse,reflex response,respiration score and total score in the analgesia group were significantly higher than those in the control group(P<0.05).The neonatal distress in the analgesia group was lower than that in the control group:4.0%(4/100)vs.15.0%(15/100),the difference was statistically significant(P<0.05).Conclusions Intravertebral labor analgesia can shorten the time of parturient delivery,reduce postpartum hemorrhage,improve the Apgar score of newborns,increase the pregnancy rate,and improve maternal and infant outcome.