椎管内麻醉联合侧卧位分娩在产程中的应用观察

Observation on the Application of Intraspinal Anesthesia Combined with Lateral Decubitus Deliver in Labor

目的观察与分析椎管内麻醉联合侧卧位分娩在产程中的应用效果。方法选取南京医科大学附属泰州人民医院2020年1月至2021年12月之间单胎头位足月初产妇120例作为研究对象,其中2020年1~12月实施椎管内麻醉、传统仰卧位分娩的60例作为对照组,2021年因科室开展自由体位结合侧卧位分娩,将其中2021年1~12月实施椎管内麻醉结合自由体位侧卧位分娩的60例作为观察组。观察两组产妇的产程时限、会阴侧切、会阴裂伤程度、镇痛满意度、产后出血等指标。结果两组产妇第二产程持续时间、会阴侧切存在明显差异(P<0.05);观察组自然分娩率显著高于对照组,产后出血量远远低于对照组(P<0.05);观察组产妇镇痛效果满意率明显高于对照组(P<0.05),两组新生儿窒息存在统计学差异(P<0.05);观察组初产妇产程舒适、对分娩过程的满意度评分更高(P<0.05)。结论椎管内镇痛产妇第一产程实施自由体位、第二产程实施侧卧位是安全且有意义的,值得在临床上推广使用。

Objective To observe and analyze the effect of intraspinal anesthesia combined with lateral decubitus deliver during labor.Methods In Taizhou People's Hospital Affiliated to Nanjing Medical University,from January 2020 to December 2021120 cases of singlet cephalic full-term primipara were served as the research objects,and 60 cases were given intraspinal anesthesia during January to December 2020 as control group.In 2021,the department carried out free position combined with lateral decubitus delivery,and 60 single cephalic full-term primiparas who received spinal anesthesia combined with free position lateral decubitus delivery from January to December are the observation group.The duration of labor,lateral perineal incision,perineal laceration degree,analgesic satisfaction,postpartum hemorrhage and other indicators were observed in the two groups.Results There were significant differences in the duration of the second stage of labor and perineal lateral incision between the two groups(P<0.05).The rate of natural delivery in the observation group was significantly higher than that in the control group,and the amount of postpartum bleeding was much lower than that in the control group(P<0.05).The satisfaction rate of maternal analgesic effect in the observation group was significantly higher than that in the control group(P<0.05),and there was statistical difference between the two groups in neonatal asphyxia(P<0.05).In the observation group,the scores of comfort and satisfaction to the labor process were higher(P<0.05).Conclusion Free postures in the first stage of labor and lateral decubitus in the second stage of labor are safe and meaningful,and worthy of clinical application.