硬膜外阻滞麻醉对临床无痛分娩效果与分娩方式及母婴健康影响
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摘要
目的分析硬膜外阻滞麻醉对临床无痛分娩效果与分娩方式及母婴健康影响。方法选取2016年12月～2017年10月在本院妇产科进行分娩的初产孕妇226例,随机分为对照组与研究组,对照组孕妇113例,进行自然分娩,即不采取麻醉止痛措施。研究组孕妇113例,对其硬膜外阻滞麻醉进行无痛分娩。比较两组初产孕妇的镇痛分娩效果、分娩方式、血流动力学动态、母婴健康情况,并在手术前1 d、2 d、3 d使用简易精神状态量表评分对初产孕妇进行认知功能评估。结果两组初产孕妇在镇痛前、宫口开3 cm、6 cm、全开时以及胎儿出生时的无痛分娩效果显示,研究组在各时点的镇痛效果与对照组比较,差异有统计学意义(P<0.05);研究组中阴道助产、自然分娩与剖宫产例数与对照组比较,差异有统计学意义(P<0.05);记录两组初产孕妇宫口开3 cm、6 cm、全开时以及胎儿出生时的HR、MAP及SpO_2等血流动力学指标,结果显示研究组中各指标与对照组比较,差异均无计学意义(P>0.05);研究组婴儿脐静脉血血气中pH值、PO_2、PCO_2、HCO~(3-)与对照组比较,差异均无统计学意义(P>0.05),研究组婴儿Apgar评分与对照组比较较,差异无统计学意义(P>0.05);研究组初产孕妇中出现产后出血、产后4 h排尿、会阴裂伤情况与对照组比较,差异均有统计学意义(P<0.05);研究组的MMSE评分与对照组比较,差异无统计学意义(P>0.05)。结论硬膜外阻滞麻醉对临床无痛分娩效果更为显著,剖宫产概率低,无认知功能障碍且不影响母婴健康。
Objective To analyze the effects of epidural anesthesia on clinical painless delivery, delivery methods, and maternal and child health. Methods A total of 226 primipara who gave birth in the Department of Gynecology and Obstetrics in our hospital from December 2016 to October 2017 were selected and randomly divided into the control group and the study group. 113 pregnant women in the control group were given natural delivery, namely no anesthesia and analgesic measures were taken. 113 pregnant women in the study group were given epidural anesthesia for painless delivery. The effects of analgesia delivery, delivery methods, hemodynamics, maternal and child health were compared between the two groups of primipara, and cognitive function assessment of primipara was performed using the Mini-Mental State Scale score at 1 day, 2 days, and 3 days before surgery. Results The painless delivery effects of the primipara in the two groups before analgesia, 3 cm, 6 cm of cervix opening, full opening, and at the birth of infant were as follows: compared with the control group, the difference of the analgesic effect in the study group at each time point was statistically significant(P<0.05); the number of cases of vaginal midwifery, natural delivery and Cesarean section in the study group were statistically significantly different from those in the control group(P<0.05); the hemodynamic parameters such as HR, MAP and SpO_2 of the primipara were recorded at 3 cm, 6 cm of cervical opening, full opening and at the time of birth in both groups. According to the research data, compared with the indicators in the control group, the differences in the study group were not statistically significant(P>0.05); compared with the blood gas indicators such as pH value, PO_2, PCO_2 and HCO~(3-)in the umbilical vein blood in the control group, there was no statistically significant difference in the data in the study group(P>0.05). There was no statistically significant difference in the Apgar score of infants between the study group and the control group(P>0.05); there were statistically significant differences in postpartum hemorrhage, urinary excretion 4 h after delivery and perineal laceration in the primipara in the study group compared with the control group(P<0.05); the MMSE score in the study group was not statistically significantly different from that in the control group(P>0.05). Conclusion Epidural block anesthesia is more significant in clinical painless delivery. The probability of cesarean section is low, and there is no cognitive dysfunction and it does not affect maternal and child health.
Objective To analyze the effects of epidural anesthesia on clinical painless delivery, delivery methods, and maternal and child health. Methods A total of 226 primipara who gave birth in the Department of Gynecology and Obstetrics in our hospital from December 2016 to October 2017 were selected and randomly divided into the control group and the study group. 113 pregnant women in the control group were given natural delivery, namely no anesthesia and analgesic measures were taken. 113 pregnant women in the study group were given epidural anesthesia for painless delivery. The effects of analgesia delivery, delivery methods, hemodynamics, maternal and child health were compared between the two groups of primipara, and cognitive function assessment of primipara was performed using the Mini-Mental State Scale score at 1 day, 2 days, and 3 days before surgery. Results The painless delivery effects of the primipara in the two groups before analgesia, 3 cm, 6 cm of cervix opening, full opening, and at the birth of infant were as follows: compared with the control group, the difference of the analgesic effect in the study group at each time point was statistically significant(P<0.05); the number of cases of vaginal midwifery, natural delivery and Cesarean section in the study group were statistically significantly different from those in the control group(P<0.05); the hemodynamic parameters such as HR, MAP and SpO_2 of the primipara were recorded at 3 cm, 6 cm of cervical opening, full opening and at the time of birth in both groups. According to the research data, compared with the indicators in the control group, the differences in the study group were not statistically significant(P>0.05); compared with the blood gas indicators such as pH value, PO_2, PCO_2 and HCO~(3-)in the umbilical vein blood in the control group, there was no statistically significant difference in the data in the study group(P>0.05). There was no statistically significant difference in the Apgar score of infants between the study group and the control group(P>0.05); there were statistically significant differences in postpartum hemorrhage, urinary excretion 4 h after delivery and perineal laceration in the primipara in the study group compared with the control group(P<0.05); the MMSE score in the study group was not statistically significantly different from that in the control group(P>0.05). Conclusion Epidural block anesthesia is more significant in clinical painless delivery. The probability of cesarean section is low, and there is no cognitive dysfunction and it does not affect maternal and child health.
引文
[1]康青乐.蛛网膜下腔阻滞联合硬膜外阻滞麻醉在无痛分娩中的临床应用[J].中国临床医生杂志,2016,44(3):86-88.
[2]程雯.罗哌卡因复合瑞芬太尼硬膜外麻醉对产妇分娩的影响[J].海南医学院学报,2016,11(8):771-773.
[3] Eisenach JC. Labor pain[J]. Pain,1990,41(1):S261-S261.
[4]李少华. PU-541蒙特利尔认知评估量表(MoCA)中文(北京)版与简易精神状态量表(MMSE)评估帕金森病患者认知功能的对比研究[C].全国神经病学学术会议.2009.
[5] Chia YY,Lo Y,Chen YB,et al. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia:A Nationwide Population-Based Retrospective Cohort Study[J]. Medicine,2016,95(16):3468-3471.
[6]顾光花,徐金贵,吴水妹.无痛分娩方式的实施对降低剖宫产率的临床作用及影响探究[J].中国性科学,2015,5(6):83-85.
[7]朱全忙.罗哌卡因复合舒芬太尼连续硬膜外镇痛用于无痛分娩的效果[J].中华全科医学,2015,13(9):1550-1551.
[8]张弛.罗哌卡因复合舒芬太尼硬膜外阻滞在分娩镇痛中的应用[J].山西医药杂志,2016,45(13):1569-1570.
[9] Xing JJ,Liu XF,Xiong XM,et al. Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle:A Randomized Controlled Trial[J]. PloS One,2015,10(9):267-272.
[10] Beaudry S,Pick J,Heerdt PM. Non-invasive cardiac output monitoring for cesarean delivery under epidural anesthesia in a patient with Marfan syndrome and cardiomyopathy[J]. International Journal of Obstetric Anesthesia,2015,25(19):82-85.
[11] Han Y,Zhang Z,Sun Q,et al. Combined spinal-epidural anesthesia for cesarean delivery in a patient with cor triloculare biventriculare[J]. Bmc Anesthesiology,2017,17(1):115-118.
[12]宗银东,聂颖,姜义铁,等.罗哌卡因硬膜外患者自控镇痛的无痛分娩效果及应激反应的临床研究[J].重庆医学,2016,45(17):2407-2409.
[13]黄亚龙.腰硬联合麻醉在无痛分娩中的应用效果及对妊娠结局的影响[J].海军医学杂志,2016,37(6):544-547.
[14]常永健,熊敏.硬膜外阻滞麻醉技术应用于无痛分娩安全有效[J].基因组学与应用生物学,2017,7(4):1418-1421.
[15]牛世坤,叶青.硬膜外阻滞联合针刺镇痛无痛分娩的临床效果观察[J].广西医科大学学报,2016,33(5):878-880.
[16] He ZY,Jiao QL,Miao Y,et al. Clinical application of combined anesthesia in cesarean section[J]. Pakistan Journal of Pharmaceutical Sciences,2015,28(6):2327-2329.
[17]方浩然,范学峰.硬膜外和脊麻在无痛分娩失败改剖宫产术中的应用效果观察[J].世界中西医结合杂志,2016,11(10):1418-1419.
[18] Liao Z,Xiong Y,Luo L. Low-dose spinal-epidural anesthesia for Cesarean section in a parturient with uncontrolled hyperthyroidism and thyrotoxic heart disease[J].Journal of Anesthesia,2016,30(4):1-4.
[19] Jianwen J,Gang W,Maowei G,et al. Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures[J]. Clinical Interventions in Aging,2015,10(8):1223-1231.
[20]马娟,周俊,田贵聪,等.不同麻醉方式无痛分娩对产妇泌乳功能及新生儿Apgar评分的影响[J].海南医学,2016,27(15):2546-2548.
[2]程雯.罗哌卡因复合瑞芬太尼硬膜外麻醉对产妇分娩的影响[J].海南医学院学报,2016,11(8):771-773.
[3] Eisenach JC. Labor pain[J]. Pain,1990,41(1):S261-S261.
[4]李少华. PU-541蒙特利尔认知评估量表(MoCA)中文(北京)版与简易精神状态量表(MMSE)评估帕金森病患者认知功能的对比研究[C].全国神经病学学术会议.2009.
[5] Chia YY,Lo Y,Chen YB,et al. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia:A Nationwide Population-Based Retrospective Cohort Study[J]. Medicine,2016,95(16):3468-3471.
[6]顾光花,徐金贵,吴水妹.无痛分娩方式的实施对降低剖宫产率的临床作用及影响探究[J].中国性科学,2015,5(6):83-85.
[7]朱全忙.罗哌卡因复合舒芬太尼连续硬膜外镇痛用于无痛分娩的效果[J].中华全科医学,2015,13(9):1550-1551.
[8]张弛.罗哌卡因复合舒芬太尼硬膜外阻滞在分娩镇痛中的应用[J].山西医药杂志,2016,45(13):1569-1570.
[9] Xing JJ,Liu XF,Xiong XM,et al. Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle:A Randomized Controlled Trial[J]. PloS One,2015,10(9):267-272.
[10] Beaudry S,Pick J,Heerdt PM. Non-invasive cardiac output monitoring for cesarean delivery under epidural anesthesia in a patient with Marfan syndrome and cardiomyopathy[J]. International Journal of Obstetric Anesthesia,2015,25(19):82-85.
[11] Han Y,Zhang Z,Sun Q,et al. Combined spinal-epidural anesthesia for cesarean delivery in a patient with cor triloculare biventriculare[J]. Bmc Anesthesiology,2017,17(1):115-118.
[12]宗银东,聂颖,姜义铁,等.罗哌卡因硬膜外患者自控镇痛的无痛分娩效果及应激反应的临床研究[J].重庆医学,2016,45(17):2407-2409.
[13]黄亚龙.腰硬联合麻醉在无痛分娩中的应用效果及对妊娠结局的影响[J].海军医学杂志,2016,37(6):544-547.
[14]常永健,熊敏.硬膜外阻滞麻醉技术应用于无痛分娩安全有效[J].基因组学与应用生物学,2017,7(4):1418-1421.
[15]牛世坤,叶青.硬膜外阻滞联合针刺镇痛无痛分娩的临床效果观察[J].广西医科大学学报,2016,33(5):878-880.
[16] He ZY,Jiao QL,Miao Y,et al. Clinical application of combined anesthesia in cesarean section[J]. Pakistan Journal of Pharmaceutical Sciences,2015,28(6):2327-2329.
[17]方浩然,范学峰.硬膜外和脊麻在无痛分娩失败改剖宫产术中的应用效果观察[J].世界中西医结合杂志,2016,11(10):1418-1419.
[18] Liao Z,Xiong Y,Luo L. Low-dose spinal-epidural anesthesia for Cesarean section in a parturient with uncontrolled hyperthyroidism and thyrotoxic heart disease[J].Journal of Anesthesia,2016,30(4):1-4.
[19] Jianwen J,Gang W,Maowei G,et al. Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures[J]. Clinical Interventions in Aging,2015,10(8):1223-1231.
[20]马娟,周俊,田贵聪,等.不同麻醉方式无痛分娩对产妇泌乳功能及新生儿Apgar评分的影响[J].海南医学,2016,27(15):2546-2548.