不同分娩镇痛时机对初产妇分娩指标和新生儿影响

Effects of different timing of labor analgesia on the labor indexes and neonates of primiparas

目的:探讨不同分娩镇痛时机对初产妇产程、产后出血、会阴侧切率及新生儿的影响。方法:选取2022年6月1日-2023年4月30日于本院分娩的100例初产妇,依据分娩镇痛时机的不同分为两组各50例,分别在产妇宫口扩张≥3cm(≥3cm组)、<3cm(<3cm组)时实施镇痛,对比两组第一产程时间、总产程时间、产后2h出血量、会阴侧切率、新生儿出生后1min、5min Apgar评分、干预前后视觉疼痛模拟评分(VAS)、分娩并发症及满意度。结果:<3cm组第一产程(9.02±1.45 h)、总产程时间(10.24±1.59 h)及产后2h出血量(243.70±23.22 ml)均低于≥3cm组(10.43±1.28 h、11.43±1.46 h、266.30±25.44 ml)(均P<0.001),两组会阴侧切率(64.0%、64.0%)及新生儿出生后1min、5min Apgar评分无差异(P>0.05);干预后两组VAS评分均下降且<3cm组(1.01±0.14分)低于≥3cm组(1.78±0.09分),<3cm组分娩并发症(4.0%)低于≥3cm组(16.0%),分娩镇痛满意度(94.0%)高于≥3cm组(80.0%)(均P<0.05)。结论:在产妇宫口扩张<3cm时实施分娩镇痛可显著缩短产程时间并降低产后出血量与新生儿不良结局风险,减轻产妇疼痛。

Objective:To investigate the effects of different timing of labor analgesia on the labor stage,the postpartum hemorrhage,the lateral perineal resection rate,and the neonates of primiparas.Methods:A total of 100primiparas who wanted delivered in hospital were selected and were divided into two groups(50cases in each group)according to their different timing of labor analgesia from June 1,2022to April 30,2023.The primiparas in group A were given labor analgesia at the cervix opened to≥3cm,while the women in group B were given labor analgesia at the cervix opened to<3cm.The durations of the first labor and the total labor,the 2hpostpartum blood loss,the lateral perineal resection rate,the neonatal Apgar score at 1min and 5min after birth,the visual analog scale(VAS)score before and after labor analgesia,the labor complications and satisfaction of the primiparas were compared between the two groups.Results:The durations of the first stage of labor(9.02±1.45h)and the total labor(10.24±1.59h),and the postpartum 2hblood loss(243.70±23.22ml)of the primiparas in group B were significantly lower than those(10.43±1.28 h,11.43±1.46h,and 266.30±25.44ml)of the primiparas in group A.There were no significant differences in the rate of episiotomy(64.0%vs.64.0%)and the neonatal Apgar scores at 1min and 5min after birth between the two groups(P>0.05).After labor analgesia,the VAS score of the primiparas in the two groups had decreased significantly,and which(1.01±0.14points)of the primiparas in group B were significantly lower than that(1.78±0.09points)of the primiparas in group A.The delivery complications rate(4.0%)of the primiparas in group B was significantly lower than that(16.0%)of the primiparas in group A,and the satisfaction of labor analgesia(94.0%)of the primiparas in group B was significantly higher than that(80.0%)of the primiparas in group A(all P<0.05).Conclusion:The administration of labor analgesia at the cervix opened to<3cm of the primiparas can significantly shorten their duration of labor,reduce their risk of postpartum hemorrhage and adverse neonatal outcomes,and alleviate the maternal pain.