高龄孕妇全产程硬膜外镇痛的安全性探讨
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摘要
目的探讨高龄孕妇全产程使用硬膜外镇痛的安全性。方法选取2018年3月1日至5月31日在广州市妇女儿童医疗中心定期产检、足月单胎头位分娩的533例孕妇为研究对象,其中年龄≥35岁、产程中使用硬膜外镇痛的143例孕妇为高龄镇痛组;年龄≥35岁、产程中未使用硬膜外镇痛的103例孕妇为高龄非镇痛组;年龄<35岁、产程中使用硬膜外镇痛的287例孕妇为非高龄镇痛组,比较高龄镇痛组孕妇与其余两组孕妇产程情况及母儿近期结局。结果高龄镇痛组和高龄非镇痛组剖宫产率比较无差异(P>0.05);高龄镇痛组孕妇的第一产程时限为(520.74±242.323)min、第二产程时限为(36.15±36.453)min、产时发热率为18.4%、阴道助产率为22.1%,均显著高于高龄非镇痛组孕妇(t/χ~2值分别为-10.017、-2.721、17.195、10.920,均P<0.05),而两组新生儿窒息率、住院率、酸中毒发生率、严重酸中毒发生率比较无显著性差异(均P>0.05)。高龄镇痛组与非高龄镇痛组新生儿窒息率、住院率、严重酸中毒发生率比较均无显著性差异(均P>0.05)。结论高龄孕妇可以安全地全产程使用硬膜外镇痛,不增加母儿不良妊娠结局的发生率。
Objective To evaluate the safety of epidural analgesia in puerperant at advanced age during the whole stage of labor. Methods Altogether 533 cases of pregnant women with full term, singleton and cephalic delivery undergoing prenatal examination and childbirth in Guangzhou Women and Children's Medical Centre from March 1 to May 31, 2018 were selected as study objects. Among them, 143 women with age ≥35 and delivering under epidural analgesia during whole labor were included in advanced age with analgesia group, 103 women with age ≥35 and delivering without epidural analgesia were included in advanced age without analgesia group, and 287 women with age under 35 and delivering under epidural analgesia during whole labor were included in normal age analgesia group. Complications during labor and maternal and neonatal outcomes were compared between advanced age with analgesia group and the other two groups. Results No statistical difference in cesarean rate was observed between advanced age with analgesia group and advanced age without analgesia group(P>0.05). First stage of labor lasted for 520.74±242.323 min, second stage of labor lasted for 36.15±36.453 min, intrapartum fever rate was 18.4% and instrumental delivery rate was 22.1% in advanced age with analgesia group, which were all higher than those in advanced age without analgesia group(t/χ~2 value was-10.017,-2.721, 17.195 and 10.920, respectively, all P<0.05). There were no significant differences in neonatal asphyxia rate, neonatal admission rate, neonatal acidosis rate and severe neonatal acidosis rate between two groups(all P>0.05). No significant differences in neonatal asphyxia rate, neonatal admission rate and severe neonatal acidosis rate were showed between advanced age with analgesia group and normal age analgesia group(all P>0.05). Conclusion It is safe for pregnant women at advanced age to use epidural analgesia during whole labor, which does not increase adverse maternal and neonatal outcomes.
Objective To evaluate the safety of epidural analgesia in puerperant at advanced age during the whole stage of labor. Methods Altogether 533 cases of pregnant women with full term, singleton and cephalic delivery undergoing prenatal examination and childbirth in Guangzhou Women and Children's Medical Centre from March 1 to May 31, 2018 were selected as study objects. Among them, 143 women with age ≥35 and delivering under epidural analgesia during whole labor were included in advanced age with analgesia group, 103 women with age ≥35 and delivering without epidural analgesia were included in advanced age without analgesia group, and 287 women with age under 35 and delivering under epidural analgesia during whole labor were included in normal age analgesia group. Complications during labor and maternal and neonatal outcomes were compared between advanced age with analgesia group and the other two groups. Results No statistical difference in cesarean rate was observed between advanced age with analgesia group and advanced age without analgesia group(P>0.05). First stage of labor lasted for 520.74±242.323 min, second stage of labor lasted for 36.15±36.453 min, intrapartum fever rate was 18.4% and instrumental delivery rate was 22.1% in advanced age with analgesia group, which were all higher than those in advanced age without analgesia group(t/χ~2 value was-10.017,-2.721, 17.195 and 10.920, respectively, all P<0.05). There were no significant differences in neonatal asphyxia rate, neonatal admission rate, neonatal acidosis rate and severe neonatal acidosis rate between two groups(all P>0.05). No significant differences in neonatal asphyxia rate, neonatal admission rate and severe neonatal acidosis rate were showed between advanced age with analgesia group and normal age analgesia group(all P>0.05). Conclusion It is safe for pregnant women at advanced age to use epidural analgesia during whole labor, which does not increase adverse maternal and neonatal outcomes.
引文
[1]Amer Soc Anesthesiologists Task FoSoc Obstet Anesthesia Perinatology.Practice guidelines for obstetric anesthesia:an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology[J].Anesthesiology,2016,124(3):270-300.
[2]Michael H,Markus K.Obstetric analgesia update 2016[J].J Perinat Med,2017,45(3):281-289.
[3]Cheng Y W,Shaffer B L,Nicholson J M,et al.Second stage of labor and epidural use: A larger effect than previously suggested[J].Obstet Gynecol,2014,123:527-535.
[4]Hasegawa J,Farina A,Turchi G,et al.Effects of epidural analgesia on labor length, instrumental delivery, and short-term outcome[J].J Anesth,2013,27(1):43-47.
[5]Wong G A.Neuraxial labor analgesia:Does it influence the outcomes of labor[J].Anesthesia Analagesia,2017,124(5):1389-1391.
[6]Atsuko O,Risa F,Sayri N,et al.Outcomes of labor epidural analgesia among wowen aged over 40:A single-institution retrospective study[J].J Obstet Gynaecol Res,2016,42(12):1712-1718.
[7]Patel N P,EI-Wahab N,Fernando R,et al.Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study[J].Anaesthesia,2014,69(5):458-467.
[8]Sharma S K,Rogers B B,Alexander J M,et al.A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor[J].Anesth Analg,2014,118(6):604-610.
[9]吕辉,包义勇.分娩镇痛中罗哌卡因+舒芬太尼不同给药方式对体温的影响[J].中国妇幼健康研究,2017,8(8):976-979.
[10]Sharma S K,Rogers B B,Alexander J M,et al.A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor[J].Anesth Analg,2014,118(6):604-610.
[11]Committee on Practice Bulletins-Obstetrics.Practice Bulletin No.177:Obstetric Analgesia and Anesthesia[J].Obstet Gyneol,2017,129(4):e73-e89.
[2]Michael H,Markus K.Obstetric analgesia update 2016[J].J Perinat Med,2017,45(3):281-289.
[3]Cheng Y W,Shaffer B L,Nicholson J M,et al.Second stage of labor and epidural use: A larger effect than previously suggested[J].Obstet Gynecol,2014,123:527-535.
[4]Hasegawa J,Farina A,Turchi G,et al.Effects of epidural analgesia on labor length, instrumental delivery, and short-term outcome[J].J Anesth,2013,27(1):43-47.
[5]Wong G A.Neuraxial labor analgesia:Does it influence the outcomes of labor[J].Anesthesia Analagesia,2017,124(5):1389-1391.
[6]Atsuko O,Risa F,Sayri N,et al.Outcomes of labor epidural analgesia among wowen aged over 40:A single-institution retrospective study[J].J Obstet Gynaecol Res,2016,42(12):1712-1718.
[7]Patel N P,EI-Wahab N,Fernando R,et al.Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study[J].Anaesthesia,2014,69(5):458-467.
[8]Sharma S K,Rogers B B,Alexander J M,et al.A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor[J].Anesth Analg,2014,118(6):604-610.
[9]吕辉,包义勇.分娩镇痛中罗哌卡因+舒芬太尼不同给药方式对体温的影响[J].中国妇幼健康研究,2017,8(8):976-979.
[10]Sharma S K,Rogers B B,Alexander J M,et al.A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor[J].Anesth Analg,2014,118(6):604-610.
[11]Committee on Practice Bulletins-Obstetrics.Practice Bulletin No.177:Obstetric Analgesia and Anesthesia[J].Obstet Gyneol,2017,129(4):e73-e89.