Effect of continuous intraspinal pump injection of patient-controlled labor analgesia in vaginal delivery
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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 
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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
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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
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