气囊仿生助产联合硬膜外麻醉分娩镇痛对剖宫产后阴道分娩女性盆底功能的影响

Effect of balloon bionic midwifery combined with epidural analgesia on pelvic floor function in vaginal birth after cesarean section

目的探讨气囊仿生助产联合硬膜外麻醉分娩镇痛对剖宫产后阴道分娩(vaginal birth after cesarean section,VBAC)女性盆底功能的影响。方法选取2020年1月至2021年12月南宁市妇幼保健院剖宫产后再次妊娠并成功阴道分娩的经产妇120例为研究对象,根据随机数字表法将其分为观察组和对照组,每组各60例。观察组产妇在分娩过程中采用气囊仿生助产联合硬膜外麻醉分娩镇痛,对照组产妇单纯采用硬膜外麻醉分娩镇痛。比较两组产妇的疼痛视觉模拟评分法(visual analogue scale,VAS)评分、会阴裂伤情况、总产程、产后出血量、新生儿窒息率及产妇产后6~8周尿失禁发生率、阴道或子宫脱垂发生率、盆底肌肌力及功能状态。结果观察组产妇的总产程显著短于对照组,产后出血量显著少于对照组,尿失禁发生率显著低于对照组(P<0.05)。观察组产妇的盆底肌肌力、盆底肌疲劳度、盆底动态压力均显著优于对照组(P<0.05)。两组产妇的会阴裂伤或侧切、阴道和子宫脱垂发生率比较差异均无统计学意义(P>0.05)。结论剖宫产后阴道试产时采用气囊仿生助产联合硬膜外麻醉镇痛可缩短产程,减少产后出血,改善产后盆底功能状况。

Objective To investigate the effect of balloon bionic midwifery combined with epidural analgesia on pelvic floor function in vaginal birth after cesarean section(VBAC).Methods From January 2020 to December 2021 in Nanning Maternal and Child Health Hospital,120 cases of successful vaginal delivery after a previous cesarean section were selected as study objects,and they were divided into observation group and control group according to random number table method,with 60 cases in each group.The observation group received balloon bionic midwifery combined with epidural anesthesia during labor,while the control group received only epidural anesthesia during labor.The visual analog scale(VAS)scores,degree of perineal tear,total duration of labor,postpartum blood loss,and neonatal asphyxia rate,the incidence of urinary incontinence,vaginal or uterine prolapse,and pelvic floor muscle strength and functional status of two groups were compared.Results The total duration of labor in observation group was significantly shorter than that in control group,the amount of postpartum blood loss was significantly lower than that in control group,and the incidence of urinary incontinence was significantly lower than that in control group(P<0.05).The strength,fatigue and dynamic pressure of pelvic floor muscle in observation group were significantly better than those in control group(P<0.05).There was no significant difference in the incidence of perineal laceration or lateral incision,vaginal and uterine prolapse between two groups(P>0.05).Conclusion The use of balloon bionic midwifery combined with epidural analgesia during vaginal trial of labor after cesarean section can shorten labor duration,reduce postpartum blood loss,and improve postpartum pelvic floor function.