两种麻醉方式对足月妊娠单胎分娩产程及分娩结果的影响

Effects of two anesthesia methods on the labor process and the delivery outcomes of primiparas with full-term singleton

目的:比较硬膜外麻醉与腰-硬联合麻醉对孕足月单胎分娩产妇的产程及分娩结果影响。方法:收集2021年1月-2023年1月在本院要求分娩镇痛的初产妇120例,按麻醉方式的不同随机分为硬膜外麻醉(单一组)与腰-硬联合麻醉(联合组)各60例。结果:两组镇痛前、镇痛1min的视觉模拟评分法(VAS)、新生儿体质量、出生后1、5、10min的Apgar评分,第一产程、第二产程、第三产程及出血量均无差异(P>0.05),与单一组相比,联合组的镇痛起效时间(3.26±0.69 min比10.25±1.25 min)、镇痛3~15min的VAS评分、总产程(306.9±42.4 min比331.8±49.5 min)、子宫复原时间(25.7±6.3d比28.1±6.8d)、产程干涉(1.7%比13.3%)、运动阻滞发生、不良反应(1.7%比13.3%)均减少,麻醉效果较好(均P<0.05)。结论:硬膜外麻醉与腰-硬联合麻醉均可用于孕足月单胎孕妇的分娩镇痛,但与硬膜外麻醉相比,腰-硬联合麻醉在镇痛起效时间、缩短产程、促进子宫复原、降低产程干涉、减少运动阻滞、改善麻醉效果、降低不良反应方面具一定优势。

Objective:To compare the effects of epidural anesthesia and combined spinal-epidural on the labor process and the delivery outcomes of primiparas with full-term singleton.Methods:A total of 120primiparas requiring labor analgesia in hospital were collected and were divided into two groups according to different anesthetic methods(60cases in per group)from January 2021to January 2023.The primiparas in group A were given epidural anesthesia and the primiparas in group B were given combined spinal-epidural anesthesia.Results:There were no significant differences in the visual analogue scale(VAS)score before analgesia and at 1min after analgesia,the neonatal weight,the neonatal Apgar score at 1,5,and 10min after birth,the durations and bleeding amounts of the first,the second,the third stage of labor of the primiparas between the two groups(P>0.05).The onset time of analgesia,the VAS score after 3-15min analgesia,the total duration of labor,the uterine recovery time,the rates of labor interference and adverse reactions of the primiparas in group A were 3.260.69min,306.9±42.4min,25.7±6.3d,1.7%,and 1.7%),which were significantly lower than those(10.25±1.25min,331.8±49.5min,28.1±6.8d,13.3%,and 13.3%)of the primiparas in group B.The motor block rate of the primiparas in group A is significantly less than that of the primiparas in group B.The anesthetic effect of the primiparas in group A was significantly better than that of the primiparas in group B(all P<0.05).Conclusion:Both the epidural anesthesia and the combined spinal-epidural can be used for labor analgesia of the primiparas with full-term singleton.Compared with those of the epidural anesthesia,the combining pinal epidural anesthesia has certain advantages in terms of analgesia onset time,shortening the labor process,promoting the uterine recovery,reducing the labor process interference,reducing the motor block,improving the anesthetic effect,and reducing the adverse reactions of the primiparas.