腰硬联合麻醉在无痛分娩产妇中的应用效果

Effect of spinal-epidural anesthesia for parturients taking painless delivery

目的探讨腰硬联合麻醉在无痛分娩产妇中的应用效果。方法选取2021年6月至2023年6月宝鸡市妇幼保健院收治的302例拟行无痛分娩的产妇进行前瞻性研究,按随机数字表法分为对照组、研究组,各151例。对照组年龄(28.69±3.77)岁,孕周(39.14±1.15)周,使用硬膜外麻醉;研究组年龄(28.72±3.81)岁,孕周(39.16±1.10)周,使用腰硬联合麻醉。比较两组产妇分娩相关指标、应激指标、分娩结局等,采用t检验、χ^(2)检验进行统计分析。结果与对照组比较,研究组第一产程、第二产程、总产程、麻醉起效时间、肠道蠕动恢复时间、住院时间、初乳时间均较短,产后2 h出血量较少,麻醉持续时间较长,差异均有统计学意义(均P<0.05);研究组产妇第二、三产程与宫口全开时视觉模拟量表(VAS)评分、分娩成功后Bro-mage评分较低,产后24 h泌乳量评分较高,差异均有统计学意义(均P<0.05)。产后24 h对照组与研究组血清皮质醇(COR)水平[(33.66±4.53)mg/L、(18.44±3.61)mg/L]、去甲肾上腺素(NE)水平[(158.16±16.54)ng/L、(142.35±15.48)ng/L]、前列腺素E2(PGE2)水平[(99.36±8.62)ng/L、(90.12±8.47)ng/L]、P物质(SP)水平[(4.12±0.58)mg/L、(3.47±0.45)mg/L]、泌乳素(PRL)水平[(245.63±24.12)μg/L、(276.30±25.78)μg/L]均高于产前,对照组血清COR、NE、PGE2、SP水平变化更明显(t=32.288、20.106、9.395、10.880,均P<0.001),研究组血清PRL水平变化更明显(t=10.675,P<0.001)。两组产妇分娩结局比较,差异均无统计学意义(均P>0.05)。结论无痛分娩产妇中应用腰硬联合麻醉,能有效缩短产程,减少应激指标、致痛因子表达,减轻疼痛程度,改善泌乳功能,且分娩结局良好。

Objective To analyze the effect of spinal-epidural anesthesia for parturients taking painless delivery.Methods A prospective study was conducted on 302 parturients who were admitted to Baoji Maternal and Child Health Hospital for painless delivery from June 2021 to June 2023.They were divided into a control group and a research group by the random number table method,with 151 cases in each group.The control group were(28.69±3.77)years old and(39.14±1.15)weeks pregnant,and took epidural anesthesia.The research group were(28.72±3.81)years old and(39.16±1.10)weeks pregnant,and took spinal-epidural anesthesia.The delivery-related indicators,stress indicators,and delivery outcomes were compared between the two groups.t andχ^(2) tests were applied.Results Compared with those in the control group,the first and second stages of labor,the total stage of labor,the onset time of anesthesia,the recovery time of intestinal peristalsis,and the hospitalization time in the research group were shorter,the bleeding volume 2 hours after delivery in the research group was lower,and the duration of anesthesia in the research group was longer;there were statistical differences(all P<0.05).The scores of the Visual Analogue Scale(VAS)in the second and third stages of labor and when the cervix was fully open and the Bro-mage score of the parturient after successful delivery in the research group were lower than those in the control group;the score of milk yield 24 h after delivery in the research group was higher than that in the control group;there were statistical differences(all P<0.05).Twenty-four hours after delivery,the serum levels of cortisol(COR)[(33.66±4.53)mg/L and(18.44±3.61)mg/L],norepinephrine(NE)[(158.16±16.54)ng/L and(142.35±15.48)ng/L],prostaglandin E2(PGE2)[(99.36±8.62)ng/L and(90.12±8.47)ng/L],substance P(SP)[(4.12±0.58)mg/L and(3.47±0.45)mg/L],and prolactin(PRL)[(245.63±24.12)μg/L and(276.30±25.78)μg/L]in the control group and the research group were higher than those before delivery,the changes of serum COR,NE,PGE2,SP,and PRL of the research group were more obvious(t=32.288,20.106,9.395,10.880,and 10.675;all P<0.001).There were no statistical differences in the delivery outcomes between the two groups(all P>0.05).Conclusion The application of spinal-epidural anesthesia in parturients taking painless delivery can shorten the labor stages,reduce the expression of stress indicators and pain-causing factors,relieve their pain,and improve their lactation function,and have good delivery outcomes.