不同时机实施腰硬联合麻醉对初产妇分娩镇痛效果及满意度的影响

Effects and satisfaction of combined spinal epidural anesthesia at different time points on labor analgesia in primiparous women

目的比较不同时机实施腰硬联合麻醉(combined spinal epidural anesthesia,CSEA)对初产妇分娩镇痛效果及满意度的影响。方法纳入504例产妇,根据宫口扩张程度实施CSEA分为:Ⅰ组(临产至宫口扩张<2 cm,n=112)、Ⅱ组(2 cm≤宫口扩张<5 cm,n=176)、Ⅲ组(宫口扩张≥5 cm,n=111),对照组(拉玛泽呼吸减痛法,n=105),比较各组分娩镇痛效果及满意度等。结果Ⅰ组、Ⅱ组在分娩镇痛4 h后视觉模拟评分(VAS)>3分,Ⅲ组在分娩镇痛3 h后VAS>3分;Ⅰ组、Ⅱ组的潜伏期、第二产程时长均较Ⅲ组、对照组延长,Ⅰ组、Ⅱ组活跃期均较对照组延长(P<0.05);Ⅰ组、Ⅱ组及Ⅲ组宫缩乏力及发热发生率均高于对照组,Ⅰ组、Ⅱ组尿潴留发生率均高于Ⅲ组及对照组(P<0.05);Ⅰ组、Ⅱ组满意度均高于Ⅲ组及对照组(P<0.05)。结论初产妇临产后至宫口开全实施CSEA均可有效缓解分娩疼痛,但在宫口5 cm内实施CSEA 4 h后、宫口>5 cm实施CSEA 3 h后,应根据产妇疼痛评分及时调整麻醉药剂量以达到有效镇痛,并及时观察与处理麻醉相关副作用,以提高产妇满意度。

Objective To compare the clinical effects of combined spinal epidural anesthesia(CSEA)at different times on the analgesic effect and satisfaction of primipara.Methods 504 primipara were included in this study.According to different degrees of cervical dilatation,the primipara with CSEA were divided into:GroupⅠ(from labor to cervical dilation<2 cm,n=112 cases),groupⅡ(2 cm≤Cervical dilation<5 cm,n=176 cases),groupⅢ(cervix dilation≥5 cm,n=111 cases),control group(no neuraxial anesthesia for labor analgesia,n=105 cases),in order to compare the effect of labor analgesia and satisfaction at different groups.Results The visual analogue scale(VAS)scores for groupⅠand groupⅡexceeded 3 points after 4 hours of labor analgesia,while the VAS scores for groupⅢexceeded 3 points after 3 hours of labor analgesia.The incubation period and the duration of the second stage of labor in groupⅠand groupⅡwere longer than those in groupⅢand control group(all P<0.05).The incidence of uterine atony in groupⅠ,groupⅡand groupⅢwere higher than those in the control group(all P<0.05).The incidence of fever and urinary retention in groupⅠ,groupⅡand groupⅢwere higher than that in control group(all P<0.05).The satisfaction levels of primiparous women in groupⅠand groupⅡwere significantly higher than those in groupⅢand control group(all P>0.05).Conclusion CSEA can effectively relieve pain for primiparous women after labor until the cervix is fully dilated.However,4 hours after CSEA within 5 cm of the cervix,3 hours after CSEA for cervix dilation larger than 5 cm,the anesthetic dose should be adjusted in time according to the pain score to achieve effective analgesia.It is important to observe and treat side effects related to anesthesia drugs in a timely manner to improve the satisfaction of primiparous women.