Effect of continuous intraspinal pump injection of patient-controlled labor analgesia in vaginal delivery
-
摘要:
目的 分析椎管内硬膜外自控镇痛(patient controlled epidural analgesia, PCEA)对阴道分娩产妇分娩疼痛、产程时间及产后并发症、盆底肌肌力的影响。 方法 选择2019年1月—2021年10月在仙居县人民医院产科阴道分娩的产妇153例，按照随机数字表法将产妇分成观察组(77例)和对照组(76例)，对照组采用常规的合理体位引导、心理疏导等分娩支持措施，观察组在此基础上采用PCEA无痛分娩技术。比较2组产妇分娩疼痛、产程时间及产后并发症、盆底肌肌力。 结果 2组产妇一般资料比较差异无统计学意义(均P＞0.05)。分娩疼痛程度: 对照组Ⅱ级18例(23.68%)，Ⅲ级58例(76.32%)；观察组0级20例(25.97%)，Ⅰ级57例(74.03%)，2组比较差异有统计学意义(Hc=128.090，P＜0.001)。2组总产程时间、第一产程时间、宫口扩张速度、胎头下降速度比较差异均有统计学意义(均P＜0.05)。2组产后尿潴留发生率比较, 差异有统计学意义(P＜0.05)。对照组产后2个月阴道内指诊盆底肌肌力评分为(2.36±0.85)分, 观察组为(3.82±0.69)分, 2组比较差异有统计学意义(t=11.672, P＜0.001)。 结论 PCEA无痛分娩技术在阴道分娩产妇中应用安全、效果好, 有利于获得更好的母婴结局。 Abstract:Objective To investigate the effects of patient-controlled epidural analgaesia (PCEA) on labour pain, labour process, postpartum complications and pelvic floor muscle strength of vaginal delivery. Methods From January 2019 to October 2021, 153 pregnant women with vaginal delivery were included in the Obstetrics Department of Xianju County People' s Hospital, they were divided into observation group (77 cases) and control group (76 cases) using random number table method. The control group used routine reasonable body position guidance, psychological counselling and other delivery support measures, whereas the observation group used PCEA painless delivery technology. Labour pain, labour process time, postpartum complications and pelvic floor muscle strength of vaginal delivery women in the two groups were compared. Results No statistical difference was found between the two groups (all P > 0.05). The levels of labour pain in the control group were as follows: 18 cases of grade Ⅱ (23.68%), 58 cases of grade Ⅲ (76.32%) in the control group, 20 cases of grade 0 (25.97%), 57 cases of grade Ⅰ (74.03%) in the observation group, there significant difference was found between the two groups (Hc=128.090, P < 0.001). There were significant differences in the total stage of labour, the first stage of labour, the rate of uterine dilatation and the rate of foetal head descent between the two groups (all P < 0.05). Difference in incidence of postpartum urinary retention was found between the groups, and the difference was statistically significant (P < 0.05). The pelvic floor muscle strength score by intravaginal digital diagnosis of the control group was (2.36±0.85) points and that of the observation group was (3.82±0.69) points, significant difference was found between the two groups (t=11.672, P < 0.001). Conclusion PCEA painless delivery technology is safe and effective in vaginal delivery, which is conducive to maternal and infant outcomes. -
表 1 2组阴道分娩产妇一般资料比较(x±s)
Table 1. Comparison of general data between two groups of parturient with vaginal delivery
组别 例数 年龄(岁) 身高(cm) 临产体重(kg) 观察组 77 26.63±2.49 160.12±3.38 68.75±7.66 对照组 76 26.82±2.55 159.45±3.78 69.41±7.43 t值 0.466 1.155 0.541 P值 0.641 0.248 0.589 
下载: 导出CSV
表 2 2组阴道分娩产妇产程进展比较(x±s)
Table 2. Comparison of labor progress between two groups of parturient with vaginal delivery
组别 例数 宫口扩张速度(cm/h) 胎头下降速度(cm/h) 第一产程时间(min) 第二产程时间(min) 第三产程时间(min) 总产程时间(min) 对照组 76 1.18±0.47 1.48±0.36 536.39±149.50 62.77±14.64 11.98±4.72 581.35±118.76 观察组 77 1.96±0.53 1.75±0.24 425.81±122.75 60.04±15.48 12.34±5.63 540.23±114.57 t值 9.634 5.451 4.997 1.121 0.310 2.179 P值 ＜0.001 ＜0.001 ＜0.001 0.262 0.757 0.029
下载: 导出CSV
表 3 2组产妇产后出血量、盆底肌肌力及新生儿Apgar评分比较(x±s)
Table 3. Comparison of incidence of postpartum adverse events between two groups of parturient with vaginal delivery
组别 例数 新生儿Apgar评分(分) 产后2 h出血量(mL) 产后2个月盆底肌肌力评分(级) 对照组 76 9.35±0.12 231.59±75.42 2.36±0.85 观察组 77 9.30±0.27 220.15±70.23 3.82±0.69 t值 1.477 0.971 11.672 P值 0.140 0.332 ＜0.001
下载: 导出CSV
-
[1] 杨丽, 史宏晖, 朱冬菊, 等. 自控镇痛无痛分娩与传统阴道分娩对盆底组织功能近期影响的临床研究[J]. 中国性科学, 2017, 26(4): 122-125. doi: 10.3969/j.issn.1672-1993.2017.04.041YANG L, SHI H H, ZHU D J, et al. Clinical study on the short-term effects of patient-controlled analgesia painless delivery and traditional vaginal delivery on pelvic floor tissue function[J]. Chin Sex Sc, 2017, 26(4): 122-125. doi: 10.3969/j.issn.1672-1993.2017.04.041 [2] NEVO A, APTEKMAN B, GOREN O, et al. Labor epidural analgesia onset time and subsequent analgesic requirements: A prospective observational single-center cohort study[J]. Int J Obstet Anesth, 2019, 40: 39-44. doi: 10.1016/j.ijoa.2019.05.008 [3] QIAN X Y, WANG Q N, OU X X, et al. Effects of ropivacaine in patient-controlled epidural analgesia on uterine electromyographic activities during labor[J]. Biomed Res Int, 2018: 7162865. DOI: 10.1155/2018/7162865. [4] BOOTH J L, ROSS V H, NELSON K E, et al. Epidural neostigmine versus fentanyl to decrease bupivacaine use in patient-controlled epidural analgesia during labor: A randomized, double-blind, controlled study[J]. Anesthesiology, 2017, 127(1): 50-57. doi: 10.1097/ALN.0000000000001669 [5] 马向莉. 自控镇痛无痛分娩与传统阴道分娩对母婴结局及产后盆底组织功能的影响分析[J]. 医学理论与实践, 2018, 31(21): 3254-3255. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL201821052.htmMA X L. Effects of patient-controlled analgesia painless delivery and traditional vaginal delivery on maternal and infant outcomes and postpartum pelvic floor tissue function[J]. Med Theory & Pract, 2018, 31(21): 3254-3255. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL201821052.htm [6] 刘莉萍, 宣荣荣, 朱虹, 等. 硬膜外分娩镇痛对产妇炎症因子、补体及免疫功能的影响分析[J]. 中华全科医学, 2019, 17(2): 241-244. doi: 10.16766/j.cnki.issn.1674-4152.000650LIU L P, XUAN R R, ZHU H, et al. Effect of epidural labor analgesia on maternal inflammatory factors, complement and immune function[J]. Chinese Journal of General Practice, 2019, 17(2): 241-244. doi: 10.16766/j.cnki.issn.1674-4152.000650 [7] 房建, 赵继蓉. 小剂量罗哌卡因联合舒芬太尼腰硬联合麻醉在无痛分娩中的应用[J]. 中华全科医学, 2018, 16(2): 264-267. doi: 10.16766/j.cnki.issn.1674-4152.000074FANG J, ZHAO J R. Application of low-dose ropivacaine combined with sufentanil combined spinal epidural anesthesia in painless delivery[J]. Chinese Journal of General Practice, 2018, 16(2): 264-267. doi: 10.16766/j.cnki.issn.1674-4152.000074 [8] 覃小菊, 黄威, 吕玉霞, 等. 经会阴三维超声观察肛提肌裂孔评估传统阴道分娩与自控镇痛无痛分娩对盆底功能的近期影响的研究[J]. 临床医学工程, 2020, 27(10): 1287-1288. doi: 10.3969/j.issn.1674-4659.2020.10.1287QIN X J, HUANG W, LV Y X, et al. Study of short-term effect of transperineal three dimensional ultrasound observation for anal levator hiatus in the evaluation of traditional vaginal delivery and painless delivery under self-controlled analgesia on pelvic floor function[J]. Clin Med Engin, 2020, 27(10): 1287-1288. doi: 10.3969/j.issn.1674-4659.2020.10.1287 [9] 刘野, 徐铭军, 赵国胜, 等. 蛛网膜下腔-硬膜外联合阻滞分娩镇痛对剖宫产术后阴道试产母婴结局影响的回顾性临床研究[J]. 国际麻醉学与复苏杂志, 2020, 41(11): 1048-1051. doi: 10.3760/cma.j.cn321761-20191117-00147LIU Y, XU M J, ZHAO G S, et al. Retrospective clinical study on the effect of combined subarachnoid epidural block labor analgesia on the outcome of vaginal trial delivery after cesarean section[J]. Intern J Anesth & Resusc, 2020, 41(11): 1048-1051. doi: 10.3760/cma.j.cn321761-20191117-00147 [10] 金珈汐, 仲莞, 陈震宇, 等. 硬膜外自控镇痛在瘢痕子宫阴道分娩中的应用[J]. 中国计划生育学杂志, 2019, 27(9): 1237-1238, 1242. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY201909034.htmJIN J X, ZHONG G, CHEN Z Y, et al. Application of patient-controlled epidural analgesia in vaginal delivery of scar uterus[J]. Chin J Fam Plann, 2019, 27(9): 1237-1238, 1242. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY201909034.htm [11] 王静, 李菊, 蔺莉, 等. 椎管内分娩镇痛在剖宫产术后再次妊娠阴道分娩中的应用[J]. 中国微创外科杂志, 2018, 18(2): 127-129, 133. doi: 10.3969/j.issn.1009-6604.2018.02.010WANG J, LI J, LIN L, et al. Application of intraspinal delivery analgesia in vaginal delivery of second pregnancy after cesarean section[J]. Chin J Minim Invas Surg, 2018, 18(2): 127-129, 133. doi: 10.3969/j.issn.1009-6604.2018.02.010 [12] 秦小凤, 秦庆华. 椎管内分娩镇痛在剖宫产术后再次妊娠阴道分娩中的应用[J]. 实用妇科内分泌杂志(电子版), 2017, 4(22): 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-FKDZ201722016.htmQIN X F, QIN Q H. Application of intraspinal delivery analgesia in vaginal delivery of second pregnancy after cesarean section[J]. J Pract Gynec Endocrin(Electronic Edition), 2017, 4(22): 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-FKDZ201722016.htm [13] 张秀华, 唐晓英, 刘先平, 等. 椎管内分娩镇痛对剖宫产术后再次妊娠妇女阴道分娩结局的影响[J]. 川北医学院学报, 2020, 35(2): 340-342. https://www.cnki.com.cn/Article/CJFDTOTAL-NOTH202002042.htmZHANG X H, TANG X Y, LIU X P, et al. Effect of intrauterine analgesia on the outcome of cesarean section[J]. J North SiChuan Med Coll, 2020, 35(2): 340-342. https://www.cnki.com.cn/Article/CJFDTOTAL-NOTH202002042.htm [14] 张风涛. 椎管内分娩镇痛在剖宫产术后再次妊娠阴道分娩中的应用价值评价[J]. 健康大视野, 2019(3): 71-72.ZHANG F T. Evaluation of intraspinal delivery analgesia in vaginal delivery of second pregnancy after cesarean section[J]. Health vis, 2019(3): 71-72. [15] 许东霞. 分娩镇痛用于剖宫产术后再次妊娠孕妇阴道试产的临床分析[J]. 中国妇幼保健, 2020, 35(8): 1425-1427. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202008021.htmXU D X. Clinical analysis of labor analgesia in vaginal trial delivery of pregnant women with second pregnancy after cesarean section[J]. China Mat & Child Health Care, 2020, 35(8): 1425-1427. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202008021.htm [16] 聂立雄, 邱全明, 张其旺. 比较不同浓度罗哌卡因复合等量舒芬太尼硬膜外分娩镇痛效果[J]. 福建医药杂志, 2018, 40(3): 39-42. https://www.cnki.com.cn/Article/CJFDTOTAL-FJYY201803014.htmNIE L X, QIU Q M, ZHANG Q W. Effect of different concentrations of ropivacaine combined with the same concentration of sufentanil for epidural labor analgesia on the labor process[J]. Fujian Medical Journal, 2018, 40(3): 39-42. https://www.cnki.com.cn/Article/CJFDTOTAL-FJYY201803014.htm -
点击查看大图
表(3)
计量
- 文章访问数: 183
- HTML全文浏览量: 110
- PDF下载量: 3
- 被引次数: 0
