不同时机自控硬膜外镇痛对产程和新生儿的影响

目的探讨不同时机实施自控硬膜外镇痛对产程进展、分娩方式和新生儿的影响。方法采用前瞻性的随机对照研究潜伏期镇痛组186例、活跃期镇痛组220例和对照组160例,观察三组孕妇产程时间、催产素的使用率、分娩方式、产后出血量、新生儿1min及5min的Apgar评分、新生儿窒息率。结果两组镇痛组均获得满意的镇痛效果,镇痛组比对照组的活跃期缩短,剖宫产率降低(P0.05);而第二产程、第三产程、产后出血量、阴道助产率、新生儿Apgar评分、新生儿窒息率在三组之间差异无统计学意义(P0.05);在潜伏期镇痛组的潜伏期有延长的趋势,催产素的使用率增加,与对照组比较差异有统计学意义(P0.05)。结论硬膜外分娩镇痛可以降低剖宫产率,不增加阴道助产率,不影响新生儿预后;潜伏期分娩镇痛是可行的。

Effect of Patient-controlled Epidural Analgesia in Different Phases of Labor on Progress of Labor and Neonatal Outcomes

Objective To explore the effect of patient-controlled epidural allalgesia on progress of labor,mode of delivery,neonatal outcomes.Methods With prospective study,566 cases were divided into three groups according to receive epidural analgesia or not,186 cases in latency analgesion group,220 cases in active analgesion group and 160 cases in control group.Length of labor,oxytocin use,way of delivery,prenatal blood loss,1-and 5-minute Apgar scores of infants and neonatal asphyxia were compared among the three groups.Results Effective labor analgesia happened at two epidural analgesia groups.Epidural analgesia could shorten labor active course and decline the cesarean section rate （P〈0.05）.No statistically significant difference was found in length of labor,prenatal blood loss,the rate of instrumental vaginal delivery,1-and 5-minute Apgar scores of infants and neonatal asphyxia rate among the three groups （P〉0.05）.Length of the latency phase of labor was longer and the rate of oxytocin use was higher in latency epidural analgesia group,and the difference was statistically significant between latency epidural analgesia group and control group （P〈0.05）.Conclusions Patient-controlled epidural analgesia can decline the cesarean section rate,but does not increase the risk of instrumental vaginal delivery and adverse effects on neonatal outcomes.It is feasible for epidural analgesia in latent phase.