腰硬联合镇痛及患者自控镇痛对产程及分娩结局的影响

摘要

目的 探讨腰硬联合(CSEA)及患者自控镇痛(PCEA)对产程及分娩结局的影响.方法 随机选取2014年1~12月足月待产、无妊娠合并症和并发症初产妇996例,其中503例产妇于活跃期实施CSEA+PCEA镇痛(分娩镇痛组),493例未行分娩镇痛(对照组),分别记录并比较两组产妇各产程时间、子宫收缩、镇痛效果、运动神经阻滞程度、产程中缩宫素的使用率、产后出血率、羊水Ⅲ度污染率、新生儿Apgar评分、产钳助产和剖宫产率.结果 分娩镇痛组第一产程、第二产程较对照组有所延长,差异有统计学意义(P<0.05);第三产程无明显改变;子宫收缩力减弱;分娩镇痛组较对照组镇痛效果显著,差异有统计学意义(P<0.05);运动阻滞程度低;缩宫素使用率、产后出血率、羊水Ⅲ度污染率、及新生儿Apgar评分及产钳助产和剖宫产率两组比较,差异均无统计学意义(P>0.05).结论 腰硬联合分娩镇痛可能会使第一产程、第二产程延长,对子宫收缩力有一定的影响,但并未增加缩宫素的使用率及产钳助产和剖宫产率,其镇痛效果显著,运动阻滞程度低,对分娩结局无不良影响.%Objective To investigate the influence of combined spinal-epidural analgesia ( CSEA) and patient-controlled epidural an-algesia(PCEA)on the labor process and delivery outcome .Methods 996 primiparas without gestational complications and comorbidity ,deliv-ered with full-term labor in our hospitalfrom Jan 2014 to Dec 2014,were randomly selected and divided into two groups:the analgesia group (503 cases of primiparas)with the rapeutic regimen of CSEA +PCEA in active stage,and the control group(493 cases)without analgesia therapy.The delivery process,uterine contraction,analgesia effect,degree of motor nerve block,rate of oxytocinuse,rate of postpartum hemor-rhage,rate of severe amniotic fluid pollution ,Apgar scores of fetus ,rate of forceps delivery and caesarean section between the two groups wer-erecorded and compared .Results The first and second stage of labor in the analgesia group were significantly longer than those in the control group( P<0.05).Noapparent difference in the third stage of labor indicatedclearly the attenuated uterine contraction after anesthesia ,but the difference of analgesia effect between themwas statistically significant ( P<0.05).The degree of motor nerve block was low .There was no sig-nificant difference in the rate of oxytocinuse and postpartum hemorrhage and severe amniotic fluid pollution ,and in the Apgar scoresof fetus and rate of forceps delivery and caesarean section between the two groups ( P>0.05 ) .Conclusion The therapeutic regimen of CSEA +PCEA may prolong the first and second stage of labor and partlyaffect the uterine contraction ,but it wouldn't increase the rate of oxytocin use-and forceps delivery and caesarean section .Furthermore,it has the advantages of significant analgesia effect ,low degree of motor nerve block and no adverse effectondelivery outcome .