活跃期分娩镇痛对经阴道分娩产妇产后认知功能的影响

目的：分析活跃期分娩镇痛与非分娩镇痛的产妇产后认知功能障碍的发生情况及其影响因素。方法：选择2016年1月—2018年12月南通市通州区二甲人民医院经阴道分娩的产妇217例，按照自愿选择的原则分为分娩镇痛组（82例）和非分娩镇痛组（135例），比较2组孕妇产程不同时间的疼痛评分以及产后第1天、第42天认知功能障碍的发生率，并分析其影响因素。结果：分娩镇痛组孕妇宫口开6 cm及10 cm时视觉模拟评分（VAS）显著低于非分娩镇痛组（P＜0.001），2组宫口开3 cm时VAS 评分差异无统计学意义（P＞0.05）；分娩镇痛组孕妇产后第1天蒙特利尔认知评估量表（MoCA）及符号数字转换测验（SDMT90）得分均高于非分娩镇痛组，认知功能障碍发生率低于非分娩镇痛组（P＜0.05），2组孕妇产后第42天MoCA、SDMT90得分及认知功能障碍发生率差异无统计学意义（P＞0.05）；未使用分娩镇痛、宫口开3 cm、6 cm、10 cm时VAS＞5分是产后第1天认知功能障碍的影响因素（P＜0.05），年龄≥35岁、高中及以下学历与产后第1天认知功能障碍无相关性（P＞0.05）。结论：分娩镇痛可以通过有效地缓解产程中疼痛来降低经阴道分娩产妇产后第1天认知功能障碍的发生风险，非分娩镇痛及产程中疼痛是产后认知功能障碍的独立危险因素。

Effects of Active Labor Analgesia on Postpartum Cognitive Function in Women with Vaginal Delivery

Objective：To analyze the occurrence and influencing factors of postpartum cognitive dysfunction in active labor analgesia and non-labor analgesia. Methods: The 217 women with vaginal delivery in our hospital from January 2016 to December 2018 were selected as the research objects. According to the principle of voluntary selection, the women were divided into the labor analgesia group (82 cases) and the non-labor analgesia group (135 cases). The pain scores at different stages of labor and the incidences of cognitive dysfunction on the first and 42nd day of postpartum were compared between the two groups, and the influencing factors were analyzed. Results: The visual analogue score(VAS) score at 6 cm and 10 cm of uterine in the labor analgesia group were significantly lower than those in the non-labor analgesia group (P＜0.001), and there was no statistical difference in the VAS score at 3 cm in labor analgesia group (P＞0.05). The scores of the Montreal cognitive assessment(MoCA) and the symbol digit modalities test(SDMT90) in the labor analgesia group were significantly higher on the first day of postpartum, and the incidence of cognitive dysfunction was lower than those in the non-labor analgesia group (P＜0.05). There were no significant differences in the scores of MoCA and SDMT90 and the incidence of cognitive dysfunction between the two groups on the 42nd day of postpartum (P＞0.05). Non-labor analgesia and VAS score＞5 at 3 cm, 6 cm and 10 cm of uterine opening were the influence factors of cognitive dysfunction on the first day of postpartum (P＜0.05). Age ≥35 years and graduated from high school and below were not correlated with cognitive dysfunction on the first day of postpartum (P＞0.05). Conclusions: Labor analgesia can reduce the risk of postpartum cognitive dysfunction on the first day of postpartum by effectively relieving labor pain while non-labor analgesia and labor pain are independent risk factors of postpartum cognitive dysfunction.