不同时期实施分娩镇痛患者剖宫产指征的差异研究

目的：探讨潜伏期与活跃期实施分娩镇痛后改行剖宫产的手术指征的差异。方法：选择足月初产妇108例，根据分娩镇痛实施时宫口开张情况分为潜伏期组（宫口〈3cm）65例和活跃期组（宫口〉13cm）43例。取同期152例未实施分娩镇痛、因试产失败改行剖宫产的产妇为对照组。记录3组产妇的剖宫产指征、术中出血量、产后24h出血量、新生儿体质量及新生儿阿普加评分。结果：潜伏期组剖宫产指征的前3位依次为活跃期停滞、胎方位异常、胎儿窘迫；活跃期组则依次为胎儿窘迫、胎方位异常、活跃期停滞。潜伏期组和活跃期产妇因胎方位异常、胎儿窘迫而改行剖宫产的比例明显高于对照组（P均〈0．05），潜伏期产妇因活跃期停滞而行剖宫产的比例明显高于活跃期组及对照组（P均〈0．05）。在不同时期实施分娩镇痛后改行剖宫产产妇术中出血量、产后24h出血量及新生儿阿普加评分差异无统计学意义（P〉0．05）。结论：不同时期实施分娩镇痛后改行剖宫产的主要指征均为胎方位异常、胎儿窘迫、活跃期停滞。在潜伏期无法耐受产痛的产妇可尽早实施分娩镇痛，但要重视产程中发生宫缩抑制等异常情况。

Study on the indications of cesarean section after labor analgesia in different labor stages

Objective： To investigate the indications of cesarean section in different labor stages. Methods： According to the different labor stages with analgesia, 108 primiparas were divided into latent group （65 cases） and active group （43 cases）. One hundred and fifty-two parturient without analgesia were included as control group. The main outcomes, such as indications of cesarean section, quantity of hemorrhage during operation, quantity of postpartum hemorrhage and Apgar scores of neonates were recorded in all cases. Results ： Abnormal fetal position, fetal distress and protracted active phase were the main indications of cesarean section in three groups. Compared with the control group, fetal distress rates were significantly lower in both latent and active groups （ P 〈 0. 05 ）. There was no significant difference in the quantities of hemorrhage or Apgar scores in different labor stages. Conclusion： Cesarean section after labor analgesia in different labor stages is indicated with abnormal fetal position, protracted active phase and fetal distress. The management of labor analgesia in latent stage should take the weakening of uterine contraction into account.