硬膜外自控镇痛在初产妇无痛分娩中的应用效果

Application effects of patient-controlled epidural analgesia in painless labor of primipara

目的:观察硬膜外自控镇痛(PCEA)在初产妇无痛分娩中的应用效果。方法:选取2020年4月至2022年4月该院收治的156例初产妇进行前瞻性研究,按照随机数字表法将其分为对照组和研究组各78例。对照组采用静脉自控镇痛,研究组采用PCEA。比较两组总产程、产后出血量、住院时间,不同时间[镇痛前(T0)、镇痛后20 min(T1)、宫口全开(T2)、分娩后即刻(T3)]疼痛程度[视觉模拟评分法(VAS)]评分,分娩前后凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(TT)、纤维蛋白原(FIB)]水平、氧化应激指标[晚期氧化蛋白产物(AOPP)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)]水平及新生儿Apgar评分。结果:研究组总产程、住院时间均短于对照组,产后出血量少于对照组,差异有统计学意义(P<0.05);T1、T2、T3时,两组VAS评分均低于T0时,且研究组低于对照组,差异有统计学意义(P<0.05);分娩后,两组APTT、PT均长于分娩前,且研究组长于对照组,两组FIB水平均高于分娩前,且研究组高于对照组,差异有统计学意义(P<0.05);两组GSH-Px、CAT、AOPP水平均高于分娩前,但研究组低于对照组,差异有统计学意义(P<0.05);研究组新生儿Apgar评分高于对照组,差异有统计学意义(P<0.05)。结论:PCEA应用于初产妇无痛分娩,可缩短总产程和住院时间,减少产后出血量,缓解产妇疼痛,改善凝血功能,减轻机体氧化应激反应,提高新生儿Apgar评分,效果优于静脉自控镇痛。

Objective:To observe application effects of patient-controlled epidural analgesia(PCEA)in painless labor of primipara.Methods:A prospective study was conducted on 156 primiparas admitted to the hospital from April 2020 to April 2022.According to the random number table method,they were divided into control group and study group,78 cases in each group.The control group was treated with patientcontrolled intravenous analgesia,while the study group was treated with PCEA.The total stage of labor,the postpartum hemorrhage volume,the hospitalization time,the pain degree[visual analogue scale(VAS)]scores at different time[before analgesia(T0),20 min after analgesia(T1),full opening of cervix(T2),immediately after delivery(T3)],the levels of coagulation function indexes[activated partial thromboplastin time(APTT),prothrombin time(TT),fibrinogen(FIB)]and oxidative stress indexes[advanced oxidation protein product(AOPP),glutathione peroxidase(GSH-Px),catalase(CAT)]before and after delivery,and the neonatal Apgar score were compared between the two groups.Results:The total stage of labor and the hospitalization time in the study group were shorter than those in the control group,the postpartum hemorrhage volume was less than that in the control group,and the differences were statistically significant(P<0.05).At T1,T2 and T3,the VAS scores of the two groups were lower than those at T0,those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).After delivery,the levels of coagulation function indexes such as APTT,PT in the two groups were longer than those before delivery,those in the study group were longer than those in the control group,and FIB in the two groups were higher than those before delivery,that in the study group was higher than that in the control group,and the differences were statistically significant(P<0.05).The levels of GSH-Px,CAT and AOPP in the two groups were higher than those before delivery,but those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the neonatal Apgar score of the study group was higher than the control group,and the difference was statistically significant(P<0.05).Conclusions:The PCEA in painless labor of primipara can shorten the total stage of labor and the hospitalization time,reduce the postpartum hemorrhage volume,relieve the maternal pain,improve the coagulation function,reduce the body’s oxidative stress response,and improve the Apgar score of newborns.Moreover,it is superior to patient-controlled intravenous analgesia.