新产程标准下不同时机分娩镇痛对初产妇分娩结局的影响

Effects of different timing of labor analgesia on delivery outcomes of primipara under the new labor standard

目的探讨新产程标准下不同时机给予分娩镇痛对初产妇产程时间、分娩方式及母婴结局的影响。方法回顾性分析2020年10月至2021年10月实施分娩镇痛的192例初产妇临床资料,将未实施分娩镇痛的60例初产妇纳入A组,将临产后到宫口扩张<3 cm实施分娩镇痛的72例初产妇纳入B组,将宫口扩张3~6 cm实施分娩镇痛的78例初产妇纳入C组。统计3组分娩方式、产程时间及母婴并发症情况,比较3组之间的差异。结果第一产程时间比较,A组>C组>B组,A组与B组、C组比较差异有统计学意义(P<0.05),B组与C组比较差异无统计学意义(P>0.05);第二产程时间比较,A组<B组<C组,A组与C组比较差异有统计学意义(P<0.05),B组与C组比较、A组与B组比较差异均无统计学意义(P>0.05);第三产程时间和总产程时间3组间比较差异无统计学意义(P>0.05)。3组间分娩方式、新生儿窒息、产后出血、产后尿潴留比较差异均无统计学意义(P>0.05)。结论初产妇在临产后至宫口扩张<3 cm时实施分娩镇痛,可加速第一产程进展,并且能减少患者分娩过程中的疼痛的时间,不增加剖宫产、阴道助产、新生儿窒息、产后出血及产后尿潴留的发生率。

Objective To investigate the effects of different time points of labor analgesia on the duration of labor,delivery mode and maternal and infant outcomes of primipara under the new labor standard.Methods The clinical data of 192 primiparas who received labor analgesia in our hospital from October 2020 to October 2021 were retrospectively analyzed.Sixty cases who did not receive labor analgesia were included in group A,72 cases who had labor analgesia at the time point of cervical dilatation<3cm were included in group B,and 78 cases who had labor analgesia at the time point of cervical dilatation of 3-6cm were included in group C.Methods of delivery,duration of labor and maternal and infant complications of the three groups were analyzed and compared among the three groups.Results The time of the first stage of labor was longest in group A,followed by group C and B.It was significantly longer in group A than that in group B and C(P<0.05),but difference was not significant between group C and group B(P>0.05).The time of the second stage of labor was longest in group C,followed by group B and A.It was significantly shorter in group A than that of group C(P<0.05),but no significant difference was detected between group B and C,and that between group A and B(P>0.05).No significant differences were detected in the time of the third stage of labor,the total labor time,method of delivery,neonatal asphyxia,postpartum hemorrhage,and postpartum urinary retention among the three groups(all P>0.05).Conclusion Delivery analgesia in primipara when the cervical dilatation is less than 3cm after delivery can accelerate the progress of the first stage of labor,and reduce the pain time during delivery without increasing the incidence of cesarean section,vaginal midwifery,neonatal asphyxia,postpartum hemorrhage and postpartum urinary retention.