产程潜伏期及活跃期行硬膜外镇痛分娩对母婴的影响

摘要

目的：比较产程潜伏期与活跃期实施硬膜外镇痛分娩对母婴的安全性。方法选择临产后自愿要求硬膜外镇痛分娩的初产妇120例，按照实施硬膜外镇痛的时机分为 L 组（潜伏期组，宫口扩张＜3 cm）和 A 组（活跃期组，宫口扩张≥3 cm）各60例；选取同期未用任何镇痛方式分娩的初产妇60例作为对照（C 组）。比较三组疼痛评分（VAS）、产程各阶段时间、催产素使用情况、镇痛时间及镇痛药物用量、分娩方式、胎儿脐动静脉血气分析和新生儿第1、5 min 时 Apgar 评分。结果L组和 A 组产程中 VAS 评分明显低于 C 组，第二产程时间、催产素使用率和使用量明显多于 C 组，且 L 组镇痛时间、镇痛药物用量及催产素使用量均高于 A 组，差异有统计学意义（P ＜0．01）。三组间转剖宫产率、脐动、静脉血 pH、氧分压（PO2）、二氧化碳分压（PCO2）、碱剩余（BE）值及新生儿 Apgar 评分比较，差异无统计学意义（P ＞0．05）。结论硬膜外镇痛分娩始于产程潜伏期和活跃期均对母婴均安全，而潜伏期镇痛可尽早减轻产妇痛苦，值得推广。%Objective To compare the safety of epidural delivery analgesia between the incubation and activation period . Methods Primiparas who choose the epidural delivery analgesia were selected as observation group ,and further divided to group L(in-cubation group;n =60,dilatation of cervix <3 cm)and group A(activation group;n =60,dilatation of cervix ≥ 3 cm).Another 60 primiparas without epidural delivery analgesia were designed as control group .The Visual Analogue Scale(VAS),the time of every labor stage,the use of oxytocin,the mode of delivery,the blood gas analysis of umbilical artery and vein ,and the neonatal Apgar score at the first and fifth minute were observed.Results There were a statistical significantly reduced VAS ,a longer second-stage of labor and an increased usage and dosage of oxytocin in the groups L and A when compare to the control group (P <0.01).Compare to the group A, there were a prolonged analgesic time,an increased usage and dosage of drug ,as well as an increased usage and dosage of oxytocin (P <0.01)in the group L.There was no statistical significance change in pH ,PO2 ,PCO2 and BE of the umbilical artery and vein and neo -natal Apgar score among the three groups (P >0.05).Conclusion It is safe for the mother and fetus whenever the epidural delivery analgesia begins at the incubation or activation period .Epidural delivery analgesia in the incubation period can be as early as possible to reduce maternal pain.This is worth to popularize.