腰硬联合阻滞分娩镇痛后中转剖宫产173例临床分析

目的 探讨腰硬联合阻滞分娩镇痛后中转剖宫产的原因及对母婴影响.方法按照ASAⅠ～Ⅱ级、单胎、足月（≥37 W）、无妊娠合并症、无明显头盆不称等标准,选择阴道试产失败而中转剖宫产的290例产妇,根据有无镇痛需求选取分娩镇痛失败后中转剖宫产产妇（173例）为镇痛组,同期未行镇痛因试产失败而中转剖宫产产妇（117例）为对照组.记录两组产妇分娩期间缩宫素的使用情况、剖宫产指征、胎方位（枕前位、枕后位、枕横位）,术中出血、羊水情况及新生儿阿普加评分.结果 导致分娩镇痛患者中转剖宫产手术的主要原因包括相对头盆不称、胎儿宫内窘迫、持续性枕后/枕横位,其中最主要的原因是相对头盆不称.与对照组比较,镇痛组产妇缩宫素使用率显著升高（P＜0.01）,胎方位为枕前位的产妇显著减少（P＜0.01）.结论 腰硬联合阻滞分娩镇痛可降低胎儿宫内窘迫的风险,但可对产妇子宫收缩产生一定影响,增加胎方位异常风险.缩宫素的有效合理使用,是保证分娩镇痛成功、降低剖宫产率的基础,但不增加母婴并发症.

Clinical analysis of 173 cases shifting to cesarean delivery after combined spinal-epidural anesthesia for labor analgesia fails

Objective To investigate relevant reasons for shifting to cesarean delivery after combined spinal- epidural anesthesia for labor analgesia fails and its effect on mother and baby.Methods 290 cases who were shifting to cesarean delivery after vaginal delivery failed according to the standards of ASA I - Ⅱ level, singleton, full-term normal delivery（≥37 weeks of gestation） and without pregnancy complications and obvious cephalo-pelvie disproportion. According to the demands of labor analgesia, 173 parturients who were shifting to cesarean delivery after labor analgesia failed were selected as the analgesia group, while 117 cases who were shifting to cesarean delivery after vaginal deliver- y（without analgesia）failed were selected as the control group.Then,the use of oxytocin, fetal positions（occiput anteri- or,occiput posterior, occipitotransverse position）, intraoperative bleeding, amniotic fluid and newborns＇ apgar scores of both groups were recorded.Results Relative cephalopelvic disproportion, fetal distress in uterus, persistent occip- itoposterior or oecipitotransverse position were the main reasons of shifting to cesarean section in the analgesia group and relative cephalopelvic disproportion was the most important reason. Compared with the control group, the oxytocin usage rate of the analgesia group was significantly higher（ P 〈0.01）,and there were less women with occiphoanterior fetal position in the analgesia group（ P 〈0.01）.Conclusion Combined spinal-epidural labor analgesia can re- duce the risk of fetal distress in uterus. However, it may influence uterine contraction and increase the risk of abnormal felal position.The rational use of oxytocin is the basis for ensuring the success of labor analgesia and low rate of cesarean section and will not increase maternal and neonatal complications.