Objective: The objective of this study was to compare the effects of epidural labor analgesia on maternal and neonatal outcomes in whole and first stage of labor, and to explore the choice of time for clinical analgesic withdrawal. Methods: A total of 539 pregnant women who underwent vaginal delivery from March 2014 to September 2017 were randomly selected for retrospective analysis. According to the time of analgesic withdrawal, they were included in the whole labor group (n=112) and the first stage of labor group (n=427). The stages of labor, the amount of postpartum hemorrhage, the changes of visual analogue score for pain (VAS), the way of delivery and the usage rate of oxytocin in the two groups were compared, and the body weight and the Apgar score of the two groups were also compared. The effects of two kinds of analgesic methods on maternal and neonatal outcomes were analyzed. Results:There was no statistically significant difference in the time for first stage of labor, time for second stage of labor and uterine recovery time between the two groups (P＞0.05). The amount of postpartum hemorrhage and cesarean delivery rate in the whole labor group were lower than those in the first stage of labor group, and the oxytocin usage rate was higher than that in the latter group (P＜0.05). Compared with the opening of the cervix to 1 cm, the scores of VAS of the opening of the cervix to 3 cm, 8 cm, the full opening of the cervix and the birth of the fetus in the two groups all decreased. Compared with the full opening of the cervix, in the birth of the fetus, the VAS scores of the two groups all increased, and the VAS score of the whole labor group was lower than that of the first stage of labor group, the difference was statistically significant (P＜0.05). There was no statistically significant difference in body weight, 1 min and 5 min Apgar scores between the two groups (P＞0.05). Conclusions: Epidural labor analgesia in the whole labor can reduce the amount of postpartum hemorrhage, the rate of cesarean section and the contraction pain of the birth of the fetus, and does not have a bad effect on the neonatal outcome. It is a recommendable scheme for labor analgesia.%目的:对比全产程与第一产程硬膜外分娩镇痛对母婴结局的影响,探讨临床镇痛停药时机的选择.方法:随机抽取2014年3月至2017年9月行阴道分娩产妇539名,进行回顾性分析.按照产妇镇痛停药时机,将其分别纳入全产程组(n=112)、第一产程组(n=427),对两组产妇产程、产后出血量、疼痛视觉模拟评分(VAS)变化以及分娩方式、缩宫素使用率进行比较,并对比两组新生儿体质量、Apgar评分,分析两种镇痛方式对母婴结局的影响.结果:两组产妇第一产程、第二产程时间及子宫复原时间比较,差异无统计学意义(P＞0.05).全产程组产后出血量、剖宫产率低于第一产程组,其缩宫素使用率高于后者,差异有统计学意义(P＜0.05).与宫口开至1 cm时相比,两组产妇宫口开至3 cm、8 cm时及宫口全开时、胎儿娩出时VAS评分均降低;与宫口全开时相比,两组产妇胎儿娩出时VAS评分均升高,全产程组胎儿娩出时VAS评分低于第一产程组,差异有统计学意义(P＜0.05).两组新生儿体质量及1 min、5 min Apgar评分比较,差异无统计学意义(P＞0.05).结论:全产程硬膜外分娩镇痛能够降低产后出血量、剖宫产率及胎儿娩出时产妇宫缩痛,且不会对新生儿结局造成不良影响,是一种值得推荐的分娩镇痛方案.
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