不同时机的硬膜外镇痛对初产妇母婴结局影响分析

Effect of different timing of epidural analgesia on maternal and infant outcomes in primiparous women

目的探讨硬膜外镇痛的不同时机对初产妇母婴结局的影响。方法选取2020年1月至2021年10月在滨州医学院附属医院住院分娩的单胎初产妇400例进行回顾性研究。按照产妇宫颈口扩张情况将其分为A、B、C三组实施分娩镇痛,其中宫颈口扩张≤3cm为A组259例,宫颈口扩张至>3~4cm为B组95例,宫颈口扩张>4cm为C组46例;比较并分析三组产妇的产程、妊娠结局[产伤、产后出血、产后贫血、疼痛视觉模拟评分(VAS)评分],以及新生儿1min和5min Apgar评分、新生儿脐动脉血血气[新生儿脐动脉血血气的血液酸碱度(pH)、动脉血氧分压(PaO2)]等指标的差异。结果A组第一产程用时显著长于B组和C组,差异有统计学意义(t=10.404,P<0.05),A组与B组比较、A组与C组比较、B组与C组比较,差异均有统计学意义(t值分别为0.015、0.036、0.008,P<0.05);A组总产程用时显著长于B组和C组,差异有统计学意义(t=8.585,P<0.05),A组与B组比较、A组与C组比较、B组与C组比较,差异均有统计学意义(t值分别为0.035、0.016、0.048,P<0.05)。A组第一产程、第二产程的VAS评分均显著低于B组和C组,差异均有统计学意义(F值分别为8.630、6.089,P<0.05);三组第三产程的VAS评分比较差异无统计学意义(P>0.05)。三组产妇导尿、会阴侧切、产后出血、中转剖宫产的发生率比较差异均无统计学意义(P>0.05)。三组新生儿1min Apgar评分和5min Apgar评分及新生儿脐动脉血血气的pH值和PaO2,以及新生儿转新生儿重症监护室(NICU)的发生率比较差异均无统计学意义(P>0.05)。结论产妇宫颈口扩张至3cm之前实施麻醉镇痛可使产妇尽早减轻疼痛,对妊娠及新生儿结局无不利影响,值得在临床推广。

Objective To explore the effect of different timing of epidural analgesia on maternal and infant outcomes in primiparous women.Methods From January 2020 to October 2021,400 singleton primiparas who gave birth in the Binzhou Medical University Hospital were selected for retrospective analysis.According to the dilatation of the maternal cervix,they were divided into the A,B,C three groups for delivery analgesia.There were 259 parturients with cervical dilatation≤3 cm in the group A,95 parturients with cervical dilatation>3-4 cm in the group B,and 46 parturients with cervical dilatation>4 cm in the group C.The differences of labor process,pregnancy outcomes[birth injury,postpartum hemorrhage,postpartum anemia,visual analogue scale(VAS)score],neonatal Apgar scores at 1 min and 5 min,neonatal umbilical artery blood gas[pondus hydrogenii(pH)and arterial partial pressure of oxygen(PO2)]among the three groups were compared and analyzed.Results The time of first labor stage of group A was significantly longer than those of group B and group C,and the differences were statistically significant(t=10.404,P<0.05).There were significant differences between group A and group B,group A and group C,and group B and group C(t=0.015,0.036 and 0.008,respectively,P<0.05).The time of total labor stage of group A was significantly longer than those of group B and group C,and the differences were statistically significant(t=8.585,P<0.05).There were significant differences between group A and group B,group A and group C,and group B and group C(t=0.035,0.016 and 0.048,respectively,P<0.05).The VAS scores of the first and second labor stages in group A were significantly lower than those of group B and group C,and the differences were statistically significant(F=8.630 and 6.089,respectively,P<0.05).There was no statistically significant difference in VAS scores of the third labor stage among the three groups(P>0.05).There were no statistically significant differences in the incidences of urinary catheterization,lateral perineal incision,postpartum hemorrhage and conversion cesarean section among the three groups(P>0.05).There were no statistically significant differences in neonatal Apgar scores at 1 min and 5 min,pH and PO2of neonatal umbilical artery blood gas,and the incidence of neonatal transfer to NICU among the three groups(P>0.05).Conclusion Anesthesia and analgesia before the cervical dilatation of 3 cm can relieve the pain of parturient as soon as possible,and has no adverse effect on pregnancy and neonatal outcomes,which is worthy of clinical promotion.