潜伏期硬膜外分娩镇痛对产程进展相关因素的影响

摘要

目的：：观察潜伏期硬膜外分娩镇痛对产妇产程进展相关因素的影响。方法：选择120例22~35岁的初产单胎头位产妇,随机分为潜伏期行硬膜外阻滞分娩镇痛组(Q 组)、活跃期行硬膜外阻滞分娩镇痛组(H 组)、非硬膜外阻滞分娩镇痛组(对照组,C 组)。比较各组各产程时间、疼痛评分、出血量。分别在分娩潜伏期开始前或开始点滴缩宫素前(时间1)、分娩后2 h离开产房前(时间2)以及分娩后24 h(时间3)3个时间点采集静脉血,测定白介素(IL-6、IL-8)和肿瘤坏死因子(TNF-α)水平。结果：Q 组和 H 组产妇第二产程较对照组有不同程度的延长,差异有统计学意义(P <0.05),3组其他产程时间差异无统计学意义(P >0.05)。3组间3个时间点的血 IL-6、IL-8和 TNF-α差异均无统计学意义(P >0.05)。结论：硬膜外阻滞分娩镇痛的产妇第二产程有不同程度的延长,但对整个产程进展影响不大,且硬膜外分娩镇痛对产妇产程进展中相关细胞因子在血液中的水平影响不大。因此,将活跃期开始的硬膜外分娩镇痛提前至潜伏期开始,能提高产妇舒适度,值得临床推广。%Objective:To observe the effects of epidural labor analgesia during latency period on factors related to labor process.Methods:A total of 120 single fetus cephalic presentation primiparas,aged from 22 to 35,were enrolled and randomly divided into group undergoing epidural labor analgesia during latency period (group Q),group undergoing epidural labor anal-gesia during active period (group H),and control group without epidural labor analgesia (group C).Duration of each labor pe-riod,pain score and amount of bleed were compared among the groups.Venous blood was collected for determination of inter-leukin (IL-6,IL-8)and tumor necrosis factor-α(TNF-α)levels before latent phase of labor or before starting infusion of oxyto-cin (time 1),2 h after delivery (time 2)and 24 h after delivery (time 3).Results:The second stage of labor in group Q or group H was longer than that in group C and the difference was statistically significant(P <0.05).However,there was no sta-tistical significance regarding other stages of labor among the three groups (P >0.05).There was no statistical significance re-garding IL-6,IL-8 and TNF-αlevels among the three groups at each of the 3 time points above (P >0.05).Conclusions:Epi-dural labor analgesia during latency period or active period could prolong the second stage of labor to different degree,but it had little effect on the entire labor process.Epidural labor analgesia had no significant effect on serum cytokines related to the birth process.Changing the time point of epidural labor analgesia from active period to latency period could improve maternal com-fort,so that it is worthy of clinical application.