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目的探讨蛛网膜下腔阻滞(腰麻)加硬膜外阻滞与单纯硬膜外阻滞对产妇产程进展的影响。方法回顾性分析722例阴道分娩健康初产妇的临床资料,根据是否行分娩镇痛及分娩镇痛方法的不同分为3组:(1)腰麻加硬膜外阻滞(联合麻醉组),共259例;(2)单纯硬膜外阻滞(硬膜外组),共215例;(3)未采用任何镇痛方法的对照组,共248例。比较3组产妇产程时间及Friedman产程图进展变化特点。结果(1)第一产程活跃期、第二产程及第三产程时间比较:联合麻醉组分别为(272±127)min、(57±36)min及(9±6)min;硬膜外组分别为(305±133)min、(59±39)min及(8±6)min;对照组分别为(188±110)min、(45±32)min及(9±6)min。联合麻醉组及硬膜外组的第一产程活跃期及第二产程时间均长于对照组(P<0.01);3组间第三产程时间相互比较,差异均无统计学意义(P>0.05)。(2)产程图特点比较:联合麻醉组及硬膜外组产妇第一产程活跃期宫缩曲线位于产程图Friedman曲线右侧,对照组则位于其左侧;联合麻醉组和硬膜外组产程图宫口曲线较Friedman曲线倾斜角度小,即第一产程活跃期进展缓慢;对照组第一产程活跃期进展较快。联合麻醉组产妇平均每小时宫口开大1.5cm,硬膜外组产妇为1.4cm,对照组产妇为1.8cm。联合麻醉组及硬膜外组产妇平均每小时宫口开大程度较对照组缩小,两者比较,差异有统计学意义(P<0.01)。结论腰麻加硬膜外阻滞联合麻醉及单纯硬膜外阻滞镇痛后,产妇第一产程活跃期进展减慢,总产程时间延长;镇痛后的产程处理不应单纯按照Friedman产程图进行。
Objective To investigate the effects of subarachnoid block (spinal anesthesia) plus epidural block and simple epidural block on the progress of labor. Methods A retrospective analysis of 722 cases of vaginal delivery of healthy primipara clinical data, depending on whether the childbirth analgesia and labor analgesia methods are divided into three groups: (1) spinal anesthesia with epidural block (combined anesthesia group) A total of 259 cases; (2) simple epidural block (epidural group), a total of 215 cases; (3) did not use any analgesic control group, a total of 248 cases. The changes of maternal labor time and the changes of Friedman labor chart were compared between the three groups. Results (1) Comparison of time of active stage, second stage of labor and third stage of labor in the first stage of labor: (272 ± 127) min, (57 ± 36) min and (9 ± 6) min in the combined anesthesia group, Were (305 ± 133) min, (59 ± 39) min and (8 ± 6) min respectively. The control group were (188 ± 110) min, (45 ± 32) min and (9 ± 6) min respectively. The active phase and the second stage of labor during the first stage of labor in the combined anesthesia group and the epidural group were longer than those in the control group (P <0.01). There was no significant difference in the third stage of labor between the three groups (P> 0.05) . (2) Comparison of labor characteristics: The contractile curve of the active stage of the first stage of labor in the combined anesthesia group and the epidural group is located on the right side of the Friedman curve of the birth chart, while the control group is on the left side. The combination anesthesia group and epidural group of labor Figure Palace mouth curve than the Friedman curve tilt angle, the slow progress of the active stage of the first stage of labor; control group, the active stage of the rapid progress of the first stage of labor. In the combined anesthesia group, the mean number of open cervix was 1.5 cm per hour, that of the epidural group was 1.4 cm, and that of the control group was 1.8 cm. In the combined anesthesia group and epidural group, the average hourly cervicocele was smaller than that in the control group. The difference was statistically significant (P <0.01). Conclusion Combined spinal anesthesia with epidural anesthesia and epidural analgesia alone, the active phase of the first stage of labor is slowed down and the total duration of labor is prolonged. The course of labor after analgesia should not be based on Friedman labor alone get on.