硬膜外鎮痛對不同孕期增重初產婦分娩結局的影響

Effect of LEA on the delivery consequences of the primiparae with different gestational weight gain

目的探討硬膜外分娩鎮痛(LEA)與不同孕期增重(GWG)初產婦分娩結局的關係。方法回顧分析經陰道分娩的共801位產婦分娩記錄。以GWG正常、孕期超重及是否接受LEA將其分為四組。Ⅰ組:GWG正常不接受LEA。Ⅱ組:GWG正常接受LEA。Ⅲ組:孕期超重不接受LEA。Ⅳ組:孕期超重接受LEA。分別記錄孕婦分娩方式、產程時間、出血量、新生兒體重、新生兒Apgar評分、產婦的鎮痛時間和順產率等。結果GWG正常產婦中,接受LEA組產婦的第一、二產程時間均長於無LEA產婦;GWG超重產婦中,接受LEA的產婦第二產程時間明顯長於無LEA產婦,其順產率顯著高於無LEA組。GWG正常且接受LEA組產婦所產新生兒的5min Apgar評分顯著低其他三組。結論產婦順產率與GWG無關。雖然接受LEA產婦的產程延長,但其順產率明顯升高。所以,對於所有初產婦,尤其對於GWG超重初產婦,值得推廣LEA。

Objective Discuss the impacts of labor epidural analgesia(LEA)on the delivery consequences of primiparae with different gestational weight gain(GWG).Methods To analyze retrospectively the delivery records of 801 pregnants who had undergone transvaginal delivery.In accordance with primiparae with normal GWG,primiparae with over-GWG and whether they had accepted LEA,the samples were divided into 4 groups.Group I:Normal GWG primiparae who didn’t accept LEA;Group II:Normal GWG primiparae who accepted LEA;Group III:Over GWG primiparae who didn’t accept LEA;Group IV:Over GWG primiparae who accepted LEA.The delivery approaches,time consumption of delivery,blood loss,weight of neonates,Apgar Scores of neonates,time consumption of LEA,natural birth rates of primiparae etc,were recorded respectively.Results Time consumptions of both Group II and Group IV primiparae were longer than Group I and Group III.The 2nd gestational stage of Group IV primiparae is obviously longer than Group III.The natural birth rate of Group IV primiparae is higher than Group III.The 5 minutes Apgar score of neonates from Group II is obviously lower than the other groups.Conclusion There is no correlation between GWG and natural birth rate.Although the delivery time consumption of primiparae who accepted LEA is elongated,the natural birth rate is obviously higher than those who didn’t accept LEA.Hence,LEA is worthy to be promoted for all primiparae especially for those over-GWG primiparae.