不同硬膜外麻醉方案对初产妇疼痛和产后盆底功能的影响

Effects of different epidural anesthesia regimens on pain and postpartum pelvic floor function of primiparas

目的观察不同硬膜外麻醉方案对初产妇分娩疼痛和产后盆底功能的影响。方法选择2021年9月至2022年9月在湖北中医药大学附属襄阳医院进行硬膜外麻醉无痛分娩的80例初产妇为研究对象,按照麻醉方案将产妇分为对照组(n=40)和观察组(n=40)。对照组产妇予以罗哌卡因复合生理盐水硬膜外麻醉,观察组产妇予以罗哌卡因复合舒芬太尼硬膜外麻醉。比较2组产妇自然分娩率、剖宫产率、阴道助产率及各个产程的时间;分别于镇痛后5 min、60 min、宫口全开以及产后24 h时采用疼痛视觉模拟评分法(VAS)评估2组产妇的镇痛效果;分别于出生后1 min和5 min采用新生儿Apgar评分评估2组新生儿窒息情况;记录2组产妇恶心呕吐、宫颈或会阴损伤、尿潴留及新生儿窒息等并发症发生情况并比较并发症总发生率。于分娩后6~8周采用生物刺激反馈仪检测2组产妇的纤维肌力、盆底肌闭合收缩力、盆底肌静态张力等盆底功能指标。结果对照组产妇的自然分娩率、阴道助产率及剖宫产率分别为72.5%(29/40)、7.5%(3/40)、20.0%(8/40),观察组产妇的自然分娩率、阴道助产率及剖宫产率分别为90.0%(36/40)、5.0%(2/40)、5.0%(2/40)。观察组产妇自然分娩率显著高于对照组,剖宫产率显著低于对照组(P<0.05);2组产妇的阴道助产率比较差异无统计学意义(P>0.05)。观察组产妇的第一产程和第二产程显著短于对照组(P<0.05),2组产妇的第三产程比较差异无统计学意义(P>0.05);观察组产妇在镇痛后5 min、60 min、宫口全开以及产后24 h时的VAS评分均显著低于对照组(P<0.05);2组新生儿产后1 min和5 min时的Apgar评分比较差异均无统计学意义(P>0.05);对照组和观察组并发症总发生率分别为42.50%(17/40)、20.00%(8/40),观察组并发症总发生率显著低于对照组(χ^(2)=4.713,P<0.05)。观察组产妇的纤维肌力和盆底肌闭合收缩力显著高于对照组,盆底肌静态张力显著低于对照组(P<0.05)。结论舒芬太尼联合罗哌卡因硬膜外麻醉能够提升初产妇的分娩镇痛效果,降低产妇剖宫产率,缩短产程,有利于产妇盆底功能的恢复,减少母婴并发症。

Objective To observe the effects of different epidural anesthesia regimens on pain degree and postpartum pelvic floor function of primiparas.Methods A total of 80 primiparas who underwent painless epidural anesthesia delivery in Xiangyang Hospital Affiliated to Hubei University of Traditional Chinese Medicine from September 2021 to September 2022 were selected as the research subjects.The primiparas were divided into control group(n=40)and observation group(n=40)according to the anesthesia plan.The primiparas in the control group received epidural anesthesia with ropivacaine combined with physiological saline,while the primiparas in the observation group received epidural anesthesia with ropivacaine combined with sufentanil.The rate of natural delivery,rate of cesarean section,rate of vaginal delivery and the duration of each labor of primiparas were compared between the two groups;the analgesic effect of primiparas in the two groups was evaluated by pain visual analogue scale(VAS)at 5,60 min after analgesia,full opening of the cervix and postpartum 24 hours;the asphyxia status of newborns in the two groups was evaluated by neonatal Apgar score at 1,5 min after birth;the complications of nausea and vomiting,cervical or perineal injuries,urinary retention of puerperas and neonatal asphyxia were recorded and the total incidence of complications was compared between the two groups.At 6-8 weeks after delivery,pelvic floor functional indicators such as fiber muscle strength,pelvic floor muscle closure contraction force,and static tension of pelvic floor muscles of postpartum women in the two groups were measured by biological stimulus feedback instrument.Results The natural delivery rate,vaginal delivery rate and cesarean section rate of primiparas in the control group was 72.5%(29/40),7.5%(3/40),20.0%(8/40),respectively;the natural delivery rate,vaginal delivery rate and cesarean section rate of primiparas in the observation group was 90.0%(36/40),5.0%(2/40)and 5.0%(2/40),respectively.The natural delivery rate of primiparas in the observation group was significantly higher than that in the control group,and the cesarean section rate was significantly lower than that in the control group(P<0.05);there was no significant difference in the vaginal delivery rate of primiparas between the two groups(P>0.05).The first and second stages of labor of primiparas in the observation group were significantly shorter than those in the control group(P<0.05),and there was no significant difference in the third stage of labor of primiparas between the two groups(P>0.05).The VAS score of primiparas in the observation group was significantly lower than that in the control group at 5,60 min after analgesia,full opening of the cervix and postpartum 24 hours(P<0.05).There was no significant difference in the Apgar score of newborns between the two groups at 1,5 min after birth(P>0.05).The total incidence of complications in the control group and the observation group was 42.50%(17/40)and 20.00%(8/40),respectively;the total incidence of complications in the observation group was significantly lower than that in the control group(χ^(2)=4.713,P<0.05).The fiber muscle strength and pelvic floor muscle closure contraction force of postpartum women in the observation group were significantly higher than those in the control group,the static tension of pelvic floor muscles was significantly lower than that in the control group(P<0.05).Conclusion Sufentanil combined with ropivacaine epidural anesthesia can improve the analgesic effect of primiparas during childbirth,reduce the cesarean section rate,shorten the labor process,and facilitate the recovery of pelvic floor function in primiparas,reduce maternal and infant complications.