硬膜外阻滞分娩镇痛的规模化实施降低临产后剖宫产率的可行性研究

目的 探讨硬膜外阻滞分娩镇痛的规模化实施对临产后剖宫产率及剖宫产指征的影响.方法 总结1999、2009年2年份1-12月所有孕足月分娩、完整在案的病历2885例,分析2年份的硬膜外阻滞分娩镇痛率、总剖宫产率及临产进入活跃期后试产失败剖宫产率及剖宫产指征的变化.结果 (1)分娩镇痛率升高,总剖宫产率下降.1999年硬膜外阻滞分娩镇痛率为17.99％,总剖宫产率为40.80％; 2009年硬膜外阻滞分娩镇痛率为51.23％,总剖宫产率为27.81％,差异有极显著性(P＜0.001).(2)临产进入活跃期后,试产不成功剖宫产率呈逐年下降趋势,1999年为6.78％,2009年为3.78％,差异有显著性(P＜0.05).(3)进入活跃期试产失败病例平均试产时间和宫颈口扩张程度呈逐年增加趋势,1999年,试产失败病例平均试产时间( 164.11±55.35) min,试产失败时平均宫口扩张程度(5.30±2.05) cm; 2009年,试产失败病例平均试产时间(284.50±84.66)min,试产失败时平均宫口扩张程度(7.00±1.83)cm;差异有显著性(P＜0.05).(4)实施规模化分娩镇痛后,头位难产发生率及社会因素剖宫产率均下降.1999年头位难产剖宫产率48.08％,2009年头位难产剖宫产率35.00％,差异有显著性(P＜0.05).1999年临产后不合理剖宫产率23.08％,2009年临产后不合理剖宫产率2.50％,差异有极显著性(P＜0.001).结论 规模化开展硬膜外阻滞分娩镇痛能降低剖宫产率特别是降低社会因素剖宫产率及临产后不合理剖宫产率降低头位难产的发生率.

The feasibility of epidural block for analgesia in labor to reduce the rate of Cesarean section after parturiency

Objective To explore the effect of epidural block for labor analgesia on the rate of Cesarean section after parturiency. Methods We summaried 2,885 pregnant women who gave full-term childbirth in our hospital in the years of 1999 and 2009. We analyzed variation of the rate of epidural block for labor analgesia and Cesarean section. The latter included the variation of the total rate of Cesarean section and of the rate of Cesarean section failing to deliver after parturiency. Results The rate of epidural block for labor analgesia was 17.99% in 1999 but 51.23% in 2009. The rate of Cesarean section was 40.80% in 1999 but 27.81% in 2009. There were significant differences in the rates of epidural block for labor analgesia and Cesarean section between the two years （ P〈 0.001 ）. The rate of Cesarean section failing to deliver after parturiency was 6.78% in 1999 and 3.78% in 2009, with a significant difference （ P〈 0.05 ）. The average time to parturiency to Cesarean section and the average degree of cervical dilatation were both increased. The average time to parturiency to Cesarean section was （ 164.11 ± 55.35 ） minutes and the dilation degree was 5.3 ± 2.05 ）cm in 1999 while it was （ 284.50 ± 84.66 ） minutes and （ 7.0 ± 1.83 ） cm in 2009, respectively; there was a significant difference between the two years P 〈 0.05 ）. The rates of ephalic dystocia and Cesarean section because of social factors were decreased after epidural block for labor analgesia. Conclusions Epidural block for labor analgesia can decrease the rates of Cesarean section and cephalic dystocia.