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目的探讨初产妇产程中腰硬联合镇痛(combined spinal-epidural analgesia,CSEA)是否增加急诊剖宫产的风险。方法选择2012年1月至2014年12月住院分娩的进行阴道试产的单胎头位足月初产妇3 456例,其中1 786例要求分娩镇痛并接受CSEA者为镇痛组,1 670例无镇痛者为对照组。比较两组孕产妇的分娩方式、缩宫素使用、产程时间和新生儿结局等临床资料。并采用多因素logistic回归模型分析控制混杂变量后的急诊剖宫产与CSEA的相关性。结果 3 456例孕产妇中,急诊剖宫产338例(9.2%),其中镇痛组剖宫产率(12.3%,219/1 786)与对照组(7.1%,119/1 670)比较,差异有统计学意义(P<0.001)。急诊剖宫产指征:产程时间延长133例,胎头位置异常114例,宫颈扩张异常12例,胎儿窘迫79例。镇痛组难产率(9.5%,169/1786)和对照组(5.4%,90/1 670)比较,差异有统计学意义(P<0.001);镇痛组胎儿窘迫发生率(2.8%,50/1786)和对照组(1.7%,29/1 670)比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄、身高、胎儿体质量、入产房时宫口扩张大小、羊水污染和产时CSEA是急诊剖宫产的独立危险因素(P<0.05);CSEA增加剖宫产风险的OR值为1.427(95%CI:1.110~1.834)。结论 CSEA可能增加了产时急诊中转剖宫产的风险,除胎位异常和胎儿窘迫外,年龄、身高、胎儿体质量和入产房时宫口扩张大小与剖宫产密切相关。
Objective To investigate whether the combined spinal-epidural analgesia (CSEA) in the first stage of delivery may increase the risk of emergency cesarean section. Methods A total of 3 456 single-term headparts of single-fetus fetuses hospitalized for delivery from January 2012 to December 2014 were enrolled in this study. Among them, 1 786 cases required labor analgesia and received CSEA as analgesia group and 1 670 cases No pain control for the control group. The clinical data of maternal delivery mode, oxytocin use, labor duration and neonatal outcome were compared between the two groups. The multivariate logistic regression model was used to analyze the correlation between emergency cesarean section and CSEA after controlling for confounding variables. Results Among 3 456 pregnant women, 338 cases (9.2%) had emergency cesarean section. The rate of cesarean section in the analgesic group (12.3%, 219/786) was significantly higher than that in the control group (7.1%, 119/1670) The difference was statistically significant (P <0.001). Emergency cesarean indications: prolonged labor duration of 133 cases, 114 cases of abnormal fetal head position, cervical dilatation in 12 cases, 79 cases of fetal distress. The difference was statistically significant (P <0.001) between the analgesic group and the control group (9.5%, 169/1786 vs 5.4%, 90/1670). The incidence of fetal distress in the analgesic group (2.8%, 50 / 1786) and control group (1.7%, 29/1 670), the difference was statistically significant (P <0.05). Multivariate logistic regression analysis showed that CSEA increased the risk of cesarean section (P <0.05) by age, height, fetal mass, uterine enlargement, amniotic fluid contamination and CSEA at delivery OR of 1.427 (95% CI: 1.110 ~ 1.834). Conclusion CSEA may increase the risk of cesarean section during delivery. In addition to the abnormal fetal position and fetal distress, CSEA may be closely related to cesarean section in terms of age, height, fetal mass and the size of the cervix.