腰硬联合麻醉分娩镇痛对产妇血清皮质醇、胃肠反应及妊娠结局影响

Influence of the combined lumbar and epidural anesthesia for labor analgesia of women on their cortisol level,gastrointestinal reaction,and pregnancy outcomes

目的:分析腰硬联合麻醉(CSEA)用于分娩镇痛效果及对产妇血清皮质醇水平、胃肠反应及妊娠结局的影响,分析不良妊娠结局的危险因素。方法:回顾性收集2019年2月-2022年12月于本院分娩的产妇中CSEA麻醉镇痛、硬膜外麻醉镇痛者各50例临床资料,依次纳入观察组和常规组,分析两组镇痛前后疼痛模拟评分(VAS)、及镇痛总有效率、血清皮质醇水平;分析两组镇痛过程中胃肠反应;多因素logistic回归分析影响不良妊娠结局危险因素。结果:镇痛后观察组VAS评分(1.01±0.23分)低于常规组(1.97±0.58分),镇痛总有效率(94.0%)高于常规组(80.0%),镇痛后两组皮质醇水平均降低且观察组(302.78±97.68 nmol/L)低于常规组(416.52±103.21 nmol/L),肠鸣音恢复时间(41.4±3.6h)、肛门排气时间(54.3±4.3h)、肠道蠕动恢复时间(33.4±3.8h)低于常规组(48.6±4.6h、59.7±5.3h、36.8±4.6h),会阴侧切、产后出血、胎儿窘迫及新生儿窒息等不良妊娠结局总发生率(20.0%)低于常规组(42.0%)(均P<0.05);胎膜早破、前置胎盘、贫血、子宫肌瘤均为影响产妇不良妊娠结局的独立危险因素(P<0.05)。结论:CSEA用于分娩镇痛可明显减轻产妇分娩疼痛,降低胃肠反应,改善血清皮质醇水平,降低不良妊娠结局发生;胎膜早破、前置胎盘、贫血、子宫肌瘤均为产妇不良妊娠结局的影响因素,临床需多加关注并合理干预以改善妊娠结局。

Objective:To analyze the influence of the combined lumbar and epidural anesthesia(CSEA)for labor analgesia of women on their cortisol level,gastrointestinal reaction,and pregnancy outcomes,and to analyze the risk factors of the adverse pregnancy outcomes of the women.Methods:50women who had received CSEA for labor analgesia from February 2019to December 2022were collected in observation group retrospectively,and 50women who had received epidural anesthesia for labor analgesia during the same period were collected in control group.The visual analogue scale(VAS)score of pain,the total effective rate of analgesia,and the serum cortisol level,the gastrointestinal reactions during labor analgesia of the women in the two groups were analyzed.Multivariate logistic regression was used to analyze the risk factors affecting the adverse pregnancy outcomes of the women.Results:After labor analgesia,the VAS score(1.01±0.23points),the recovery time of bowel sound(41.4±3.6h),the anal exhaust time(54.3±4.3 h),the intestinal peristalsis recovery time(33.4±3.8h),and the total incidence(20.0%)of the adverse pregnancy outcomes,such as episiotomy,postpartum hemorrhage,fetal distress,and neonatal asphyxia,of the women in the observation group were significantly lower than those(1.97±0.58points,48.6±4.6h,59.7±5.3h,36.8±4.6h,and 42.0%)of the women in the control group.The cortisol level of the women in the two groups had decreased significantly,and which(302.78±97.68nmol/L)of the women in the observation group was significantly lower than that(416.52±103.21nmol/L)of the women in the study group.The total effective rate of analgesia(94.0%)of the women in the observation group was significantly higher than that(80.0%)of the women in the control group(all P<0.05).The premature rupture of membranes,placenta previa,anemia,and uterine fibroids of the women were all the independent risk factors of their adverse pregnancy outcomes(P<0.05).Conclusion:CSEA used for labor analgesia of the women can significantly reduce their labor pain,decrease their gastrointestinal reactions,improve their serum cortisol levels,and reduce the risk of their adverse pregnancy outcomes.The premature rupture of membranes,placenta previa,anemia,and uterine fibroids of the women are all the factors affecting their adverse maternal pregnancy outcomes,and which should be paid attention to in clinic so as to improve the pregnancy outcomes of the women.