分娩镇痛对初产妇产程的影响

摘要

目的:探讨分娩镇痛对初产妇产程的影响.方法:回顾性分析2008年6月至2013年6月在四川大学华西第二医院经阴道分娩的1367例自然临产的初产妇资料.按是否实施分娩镇痛,分为镇痛组和非镇痛组,比较组间产程时限及宫口扩张等指标的差异,并进行分层分析以排除待产过程中其他干预措施(人工破膜及缩宫素使用)对产程的影响.结果:1367例自然临产初产妇,各产程的平均值及上限值分别为第一产程8.3小时和16.0小时,第二产程44分钟和106分钟、总产程9.1小时和16.9小时;宫口扩张至6 cm时产程加速,产程曲线呈平滑上升趋势,无明显减速期.镇痛组第一产程(潜伏期、活跃期)、第二产程、总产程的平均时间均较非镇痛组显著延长(P＜0.05);镇痛组、非镇痛组分别于宫口扩张至6 cm、5 cm时产程加速.分层分析显示,产程干预组及非干预组中,分娩镇痛均可延长第一产(潜伏期、活跃期),但对第二产程、第三产程的影响不一致.结论:实施分娩镇痛会减慢宫口的扩张,并延长第一产程.自然分娩产妇的产程曲线呈平滑上升趋势,无明显减速期.%Objective:To investigate the impact of analgesia on the stages of labor.Methods:A retrospective analysis was conducted on the data of 1367 primiparas who had spontaneous delivery at West China Second University Hospital of Sichuan University from June 2008 to June 2013.1367 primiparas were divided into analgesia group and non-analgesia group,we further stratified the analyses to exclude the interference of other labour intervention.The difference in the stages of labor and cervical dilatation between the two groups were analyzesd.Resuits:In 1367 primiparas,the mean time and upper limit valuel was 8.3h and 16.Oh respectively of first stage of labor,44min and 106min of second stage,9.1 h and 16.9h of the total stage.The labor accelerated when the cervix dilates to 6cm and the labor curve presented a smoothly ascending trend without deceleration phase.In the analgesia group,the mean time of the first stage of labor (include latent phase and active phase),the second stage of labor,the total stage were longer than those of non-analgesia group(P ＜ 0.05).The labor acceleration of analgesia and non-analgesia group began at the cervical dilatation to 6cm and 5cm respectively.And the results of stratified analyses showed that both in the stage interference group and the non stage interference group,analgesia could prolong the the first stage of labor and active phase,however the impact to the second stage of labor and the total stage was different.Conclusions:Analgesia can delay cervical dilatation and first stage of labor.The labor curve of primiparas who have spontaneous delivery presents a smoothly ascending trend without obvious deceleration phase.