瘢痕子宫再次妊娠产妇行椎管内分娩镇痛的效果
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摘要
目的观察瘢痕子宫再次妊娠产妇行椎管内分娩镇痛的安全性和有效性。方法选择2017年5月至2018年4月我院收治的瘢痕子宫再次妊娠同意阴道试产单胎足月头位产妇101例,随机选取分娩镇痛产妇70例为观察组,其中硬膜外分娩镇痛(E组)36例,腰-硬联合分娩镇痛(C组)34例,同期未镇痛产妇31例为对照组(N组)。记录产妇各产程时间、出血量、新生儿1、5 min Apgar评分、阴道分娩、产钳助产、子宫破裂情况,记录镇痛前、给药后5、10、20 min产妇NRS评分和Bromage评分。结果与N组比较,E组和C组第二产程时间明显延长(P<0.05);E组出血量高于N组及C组,但差异无统计学意义。三组第一、第三产程时间、新生儿1、5 min Apgar评分、阴道分娩、产钳助产、子宫破裂发生率差异无统计学意义;镇痛后E组和C组NRS评分均呈下降趋势。与E组比较,C组NRS评分明显降低(P<0.05)。结论瘢痕子宫再次妊娠产妇采用椎管内分娩镇痛安全可行,不降低阴道分娩率,不增加出血量以及产钳助产、子宫破裂发生率。腰-硬联合分娩镇痛较硬膜外分娩镇痛的镇痛效果好。
Objective To observe the security and effectivencess of intraspinal labor analgesia on puerpera with scar uterus undergoing re-pregnancy. Methods A cohont study was conducted to analyze full-term vaginal birth of a cesarean parturients admitted to our hospital from May 2017 to April 2018. Seventy cases receiving analgesia were randomly selected, among whom 36 receiving epidural labor analgesia(group E), while 34 receiving spinal epidural labor analgesia(group C). Meanwhile, 31 cases didn't choose labor analgesia(group N). All delivery women's labor duration, blood loss, Apgar score, the probability of vaginal delivery, using obstetric forceps, uterine rupture, NRS score and Bromage score in group E and group C were recorded. Results Compared with group N, the duration of second stage of labor was significantly lengthened in group E and group C(P < 0.05). Although delivery women's blood loss in group E was higher than group N and group C, there were no significant differences. The duration of the first stage and third stage of labor, Apgar score, incidence of vaginal delivery, device midwifery and uterine rupture among the three groups were compared. There were no significant differences. After analgesia, delivery women's NRS scores in group E and group C were decreasing. Compare with group E, delivery women's NRS scores in group C were lower(P < 0.05). Conclusion Intraspinal labor analgesia in patients with scar uterus undergoing re-pregnancy and vaginal delivery is safe and feasible. Intraspinal block for labor analgesia is effective, without reducing vaginal delivery rate, without increasing postpartum bleeding, the probability of using obstetric forceps and uterine rupture. Spinal epidural labor analgesia has better analgesia effect than epidural labor analgesia.
Objective To observe the security and effectivencess of intraspinal labor analgesia on puerpera with scar uterus undergoing re-pregnancy. Methods A cohont study was conducted to analyze full-term vaginal birth of a cesarean parturients admitted to our hospital from May 2017 to April 2018. Seventy cases receiving analgesia were randomly selected, among whom 36 receiving epidural labor analgesia(group E), while 34 receiving spinal epidural labor analgesia(group C). Meanwhile, 31 cases didn't choose labor analgesia(group N). All delivery women's labor duration, blood loss, Apgar score, the probability of vaginal delivery, using obstetric forceps, uterine rupture, NRS score and Bromage score in group E and group C were recorded. Results Compared with group N, the duration of second stage of labor was significantly lengthened in group E and group C(P < 0.05). Although delivery women's blood loss in group E was higher than group N and group C, there were no significant differences. The duration of the first stage and third stage of labor, Apgar score, incidence of vaginal delivery, device midwifery and uterine rupture among the three groups were compared. There were no significant differences. After analgesia, delivery women's NRS scores in group E and group C were decreasing. Compare with group E, delivery women's NRS scores in group C were lower(P < 0.05). Conclusion Intraspinal labor analgesia in patients with scar uterus undergoing re-pregnancy and vaginal delivery is safe and feasible. Intraspinal block for labor analgesia is effective, without reducing vaginal delivery rate, without increasing postpartum bleeding, the probability of using obstetric forceps and uterine rupture. Spinal epidural labor analgesia has better analgesia effect than epidural labor analgesia.
引文
[1] 沈晓凤,姚尚龙.分娩镇痛专家共识(2016版).临床麻醉学杂志,2016,32(8):816-818.
[2] Declercq ER,Sakala C,Corry MP,et al.Listening to mothers II:report of the Second National U.S.Survey of women's childbearing experiences:conducted january-february 2006 for childbirth connection by harris interactive(R) in partnership with lamaze international.J Perinat Educ,2007,16(4):15-17.
[3] 侯磊,李光辉,邹丽颖,等.全国剖宫产率及剖宫产指征构成比调查的多中心研究.中华妇产科杂志,2014,49(10):728-735.
[4] 黄早秀.剖宫产术瘢痕子宫再次妊娠阴道分娩的安全性及可行性.当代医学,2017,23(29):144-145.
[5] 李秋红,徐铭军.椎管内分娩镇痛对子宫收缩持续时间和间隔时间的影响.首都医科大学学报,2013,34(5):655-659.
[6] 黄晓戈.分娩镇痛对降低剖宫产率的影响.临床医药文献电子杂志,2017,4(24):4596.
[7] Reitman E,Conell-Price J,Evansmilth J,et al.β2 -adrenergic receptor genotype and other variables that contribute to labor pain and progress.Anesthesiology,2011,114(4):927.
[8] Gillesby E,Burns S,Dempsey A,et al.Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.J Obstet Gynecol Neonatal Nurs,2010,39(6):635-644.
[9] Wong CA.The influence of analgesia on labor—is it related to primary cesarean rates?Semin Perinatol,2012,36(5):353-356.
[10] Ouzounian J,Miller DA,Hiebert CJ,et al.Vaginal birth after cesarean section:risk of uterine rupture with Labor Induction.Am J Perinatol,2011,28(8):593-596.
[11] Rimaitis K,Klimenko O,Rimaitis M,et al.Labor epidural analgesia and the incidence of instrumental assisted delivery.Medicina (Kaunas),2015,51(2):76-80.
[12] 陈秀斌,周健,单震丽,等.低浓度罗哌卡因复合小剂量舒芬太尼椎管内分娩镇痛在剖宫产术后再次妊娠阴道分娩中的应用.现代妇产科进展,2014,23(10):804-806.
[2] Declercq ER,Sakala C,Corry MP,et al.Listening to mothers II:report of the Second National U.S.Survey of women's childbearing experiences:conducted january-february 2006 for childbirth connection by harris interactive(R) in partnership with lamaze international.J Perinat Educ,2007,16(4):15-17.
[3] 侯磊,李光辉,邹丽颖,等.全国剖宫产率及剖宫产指征构成比调查的多中心研究.中华妇产科杂志,2014,49(10):728-735.
[4] 黄早秀.剖宫产术瘢痕子宫再次妊娠阴道分娩的安全性及可行性.当代医学,2017,23(29):144-145.
[5] 李秋红,徐铭军.椎管内分娩镇痛对子宫收缩持续时间和间隔时间的影响.首都医科大学学报,2013,34(5):655-659.
[6] 黄晓戈.分娩镇痛对降低剖宫产率的影响.临床医药文献电子杂志,2017,4(24):4596.
[7] Reitman E,Conell-Price J,Evansmilth J,et al.β2 -adrenergic receptor genotype and other variables that contribute to labor pain and progress.Anesthesiology,2011,114(4):927.
[8] Gillesby E,Burns S,Dempsey A,et al.Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.J Obstet Gynecol Neonatal Nurs,2010,39(6):635-644.
[9] Wong CA.The influence of analgesia on labor—is it related to primary cesarean rates?Semin Perinatol,2012,36(5):353-356.
[10] Ouzounian J,Miller DA,Hiebert CJ,et al.Vaginal birth after cesarean section:risk of uterine rupture with Labor Induction.Am J Perinatol,2011,28(8):593-596.
[11] Rimaitis K,Klimenko O,Rimaitis M,et al.Labor epidural analgesia and the incidence of instrumental assisted delivery.Medicina (Kaunas),2015,51(2):76-80.
[12] 陈秀斌,周健,单震丽,等.低浓度罗哌卡因复合小剂量舒芬太尼椎管内分娩镇痛在剖宫产术后再次妊娠阴道分娩中的应用.现代妇产科进展,2014,23(10):804-806.