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目的探讨蛛网膜下腔阻滞(腰麻)-硬膜外联合麻醉和产妇自控硬膜外镇痛(CSEA+PCEA)在分娩镇痛过程中对产程进展、分娩方式及母儿预后的影响。方法回顾性分析406例初产妇病历资料,观察组(CSEA+PCEA)共135例,对照组(产程中未采用任何镇痛措施)282例,比较两组产程经过、分娩方式及母儿结局。结果观察组活跃期及第二产程时间分别为(223.33±105.84)min、(58.74±33.15)min,对照组为(176.14±99.66)min、(46.71±33.69)min,两组比较有统计学意义(P<0.01);观察组出现产程中需缩宫素加强宫缩及活跃期停滞的发生率分别为60.00%、6.67%,对照组为27.68%、2.34%,两组比较有统计学意义(P<0.001、P=0.034);观察组剖宫产率(11.85%)、产程中尿潴留的发生率(55.56%)较对照组(分别为5.54%、33.58%)比较差异有统计学意义(P=0.024、P<0.001);难产手术(产钳助产+剖宫产)、羊水改变、第三产程、产后出血、新生儿Apgar评分、新生儿窒息及产后尿潴留的发生率两组比较差异均无统计学意义。结论CSEA+PCEA镇痛对产程进展存在一定的影响,但是对分娩结局及母儿的近期预后无明显影响。
Objective To investigate the effects of subarachnoid block (spinal anesthesia) - epidural anesthesia and maternal-controlled epidural analgesia (CSEA + PCEA) on labor process, delivery mode and maternal and child prognosis during labor analgesia. Methods The data of 406 cases of primipara were retrospectively analyzed. There were 135 cases in the observation group (CSEA + PCEA) and 282 cases in the control group (no analgesia measures in the labor course). The course of labor, mode of delivery and maternal and child outcomes in the two groups were compared. Results The active phase and the second stage of labor in the observation group were (223.33 ± 105.84) min and (58.74 ± 33.15) min respectively, while the control group was (176.14 ± 99.66) min and (46.71 ± 33.69) min respectively, with statistical significance (P <0.01). In the observation group, the incidences of oxytocin constriction and active stagnation in the labor course were 60.00% and 6.67%, respectively, and those in the control group were 27.68% and 2.34% respectively. The two groups were statistically significant (P <0.001, P = 0.034). The incidence of cesarean section in the observation group (11.85%) and urinary retention in the labor course (55.56%) were significantly different from those in the control group (5.54%, 33.58% P = 0.024, P <0.001). The incidences of dystocia (forceps midwifery + cesarean section), amniotic fluid changes, the third stage of labor, postpartum hemorrhage, neonatal apgar score, neonatal asphyxia and postpartum urinary retention were significantly different between the two groups No statistical significance. Conclusion The analgesia of CSEA + PCEA has certain influence on the progress of labor, but it has no obvious effect on the delivery outcome and the immediate prognosis of maternal and child.