硬膜外分娩镇痛对分娩方式影响的回顾性分析

目的 评价硬膜外分娩镇痛对分娩方式的影响.方法 将我院2005年1月至2006年12月的临床分娩资料,按年和月分别统计硬膜外分娩镇痛率、顺产率、产钳率和剖宫产率;收集接受硬膜外分娩镇痛而以剖宫产结束分娩的产妇资料.分娩镇痛的方法是待产妇宫口开至2 cm以上时采用0.15%罗哌卡因或0.1%罗哌卡因复合2 mg/L芬太尼硬膜外镇痛,首剂负荷量10ml～12ml,背景量5 ml/h～8 ml/h,患者自控镇痛量1ml～5 ml,锁定时间15 min,宫口开全停泵.结果 与2005年比较,2006年硬膜外分娩镇痛率升高(21.90%对33.8%,P＜0.05),顺产率升高(51.7%对55.2%,P＜0.05),剖宫产率降低(43.9%对40.1%,P＜0.05),产钳率无明显变化(4.4%对4.7%,P＞0.05).随着每月硬膜外分娩镇痛率由8.4%升至41.2%时,剖宫产率由46.9%降至37.6%,两者之间呈负相关(r=0.678,P＜0.05).两年共完成硬膜外分娩镇痛5 461例,其中1125例(20.6%)以削宫产结束分娩,原因分别为胎儿窘迫371例(33.0%),头盆不称323例(28.7%),持续性枕后位或枕横位219例(19.5%),活跃期停滞141例(12.5%),发烧44例(3.9%),其他原因26例(2.3%).结论 硬膜外分娩镇痛为畏惧产痛而要求削宫产的产妇提供了自然分娩的机会,在一定程度上能够降低剖宫产率、提高自然分娩率;但接受硬膜外分娩镇痛而以剖宫产结束分娩的产妇,剖宫产的原因是否与分娩镇痛有关还需进一步研究.

Retrospective analysis on the influence of epidural labor analgesia in delivery manner

Objective To evaluate the influence of epidural labor analgesia in delivery manner. Methods The rates of epidural analgesia, spontaneous vaginal delivery, forceps delivery and cesarean section were calculated yearly and monthly from January of 2005 to December of 2006. The data of parturients who accepted epidural analgesia but deliveried with caesarean section were collected after a initina bolus, patient-controlled epidural analgesia(PCEA) started using 0.15% ropivacaine or 0.1% ropivacaine with 2 mg/L fentanil, with a bolus of 1～5ml, lockout interval of 15min and background infusion of 5 ml/h～8 ml/h when the cervix dilated at least 2 cm. Epidural infusion stopped at the moment of complete cervical dilatation. Results Compared to that in 2005, the rate of epidural labor analgesia(21.9% vs 33.8%, P＜0.05) and the rate of spontaneous vaginal delivery increased(51.7% vs 55.2%, P＜0.05) in 2006, the rate of forceps delivery unchanged(4.4%vs 4.7%, P＞0.05) and the rate of caesarean section decreased(43.9% vs 40.1%, P＜0.05) in 2006. The monthly rate of epidural analgesia was negatively correlated to the monthly rate of cesarean section (r=-0.678, P＜0.05). Conclusion Epidural labor analgesia provides opportunities of natural delivery for parturients who request cesarean section because of fearing labor pain, it decreases the rate of caesarean section, and increases the rate of spontaneous vaginal delivery to a certain extent. Whether epidural analgesia is responsible for the case of cesarean section needs further study.