產程後期硬膜外鎮痛對初產婦分娩結局的影響

The impact of epidural analgesia in later stage of labor to the outcome of primipara pregnacy

目的探討在第一產程後期(宮口大於或等於5cm)時施行硬膜外分娩鎮痛對初產婦分娩結局的影響。方法回顧分析2017~2018年兩年間本院接受硬膜外分娩鎮痛的初產婦分娩記錄資料,按鎮痛時產婦宮口的擴張程度分為三組:宮口大於或等於5cm(第一產程後期)時施行鎮痛的60例初產婦為Ⅰ組;宮口小於3cm時施行鎮痛的60例初產婦為Ⅱ組;宮口大於或等於3cm並小於5cm時施行鎮痛的60例初產婦為Ⅲ組。所有產婦自願接受分娩鎮痛,記錄所有產婦的分娩方式、第一產程時間、第二產程時間、出血量、新生兒1、5min的Apgar評分和產婦從施行硬膜外分娩鎮痛到第一產程結束的時間。結果三組產婦的順產率相若(P>0.05);三組產婦第一產程時間、第二產程時間、出血量和新生兒1、5min的Apgar評分差異無統計學意義(P>0.05);三組產婦施行分娩鎮痛後宮口擴張的速度相若,差異無統計學意義(P>0.05)。結論在第一產程後期(宮口大於或等於5cm)時施行硬膜外分娩鎮痛安全可行,但會影響產婦宮口的擴張速度。

Objective To investigate the effect to the primipara who received epidural analgesia in later phase of the first stage of labor(uterine cervix dilation≥5cm).Methods Retrospective analysis of the deliveries were recorded between 2017 to 2018 in our hospital.180 primipara were divided into three groups,group I,60 cases,received epidural analgesia when their uterine cervix dilated to 5cm;group II.60 cases,epidural analgesia performed when uterine cervix dilation was less than 3cm;group III,60 cases,cervix dilation was between 3-5cm.The mode of delivery,duration of first and second stage of labor,blood loss,Apgar score in the first and fifth minute of the newborn,and the duration from the implementation of epidural procedure to the full dilation of the uterine cervix were studied.Results The ratio of natural childbirth in three groups was similar(P>0.05),there was no significant difference in duration of stage one and stage two and amount of bleeding and Apgar scores between those in three groups(P>0.05),The velocity of uterine cervix dilation in three groups was similar(P>0.05).Conclusion It is safe and effective to perform epidural analgesia in later phase(cervix dilated more than 5cm)of the first stage of labor in primipara,without affecting the velocity of cervical dilation.