不同时机行硬膜外分娩镇痛对初产妇产程及早期盆底功能的影响

摘要/Abstract

摘要： 目的：探讨不同时机行硬膜外分娩镇痛对初产妇的产程时间及早期盆底功能的影响。方法：选取我院收治的291例阴道分娩初产妇，按随机数字表法分为三组（A、B、C组），A组93例与B组96例分别从分娩潜伏期、活跃期行硬膜外镇痛，C组102例为无镇痛的自然分娩，对三组的产程时间、催产素使用率和用量、盆底功能指标、盆腔器官脱垂定量（POP-Q）分期、盆底功能障碍性疾病（PFD）发生率进行比较。结果：A组与B组第一产程时间相比C组缩短（P<0.05），三组的第二产程、第三产程差异均无统计学意义（P>0.05）； A组与B组在催产素使用率和用量上均高于C组（P<0.05）。产后6周A组与B组在盆底纤维肌力、盆底肌静态张力以及闭合收缩力等盆底功能指标均高于C组，而盆底肌肉疲劳度相比C组降低（P<0.01）；A组与B组POP-Q分期中Ⅰ、Ⅱ、Ⅲ、Ⅳ期的比例相比C组降低（P＜0.05）；A组与B组的盆腔脏器脱垂（POP）、压力性尿失禁（SUI）、产后性功能障碍（PFSD）发生率低于C组（P＜0.05）。与A组相比，B组在产程时间、盆底功能指标、POP-Q分期、PFD发生率差异均无统计学有意义（P>0.05），只在催产素用量上A组高于B组（P<0.05）。结论：从临产时（宫口开1～2 cm）即开始行硬膜外分娩镇痛能缩短分娩潜伏期时间，降低分娩对女性盆底肌群的损伤，安全可行。

关键词: font-size:medium, ">硬膜外分娩镇痛；初产妇；产程；盆底功能

Abstract: Objective： To investigate the effect of epidural analgesia on the progress of labor and early pelvic floor function of primipara. Methods： 291 cases of vaginal deliveries primipara in our hospital were randomly divided into three groups (group A， B， C) according to random number table， including 93 cases received epidural analgesia at latent stage (A group)， 96 cases received epidural according to random analgesia at active stage (B group)， 102 cases did receive analgesia (C group). The labor process， oxytocin usage rate and dosage， indexes of pelvic floor function， POP-Q stage assessment and the incidence of pelvic floor dysfunction(PFD) were compared between the three groups. Result： The time of the first stage of labor of group A and B were significantly shorter than that of group C (P<0.05)， and there was no difference among the three groups in the second stage and the third stage of labor (P>0.05). The oxytocin usage rate and dosage in group A and B were significantly higher than those in group C (P<0.05). At 6 weeks postpartum， the indexes of pelvic floor function such as pelvic floor fiber excitation, static tension of pelvic floor muscle, close contraction of pelvic floor muscle in group A and B were significantly better than those in group C (P<0.01)， pelvic floor muscle fatigue in group A and B were lower than that in group C（P<0.01）， the POP-Q of stageⅠ， Ⅱ， Ⅲ， Ⅳ in group A and group B were significantly lower than that in group C (P<0.05)， the incidence of POP， SUI and PFSD in group A and B were significantly lower than that in group C (P<0.05). Compared with group A， group B had no difference in labor time， pelvic floor function index， POP-Q stage and PFD incidence (P>0.05). Only in oxytocin dosage， group A was significantly higher than that of group B (P<0.05). Conclusion： It is safe and feasible to apply epidural analgesia at the time of uterine opening 1-2 cm which can could shorten the first stage of labor and reduce the damage of female pelvic floor muscles.

Key words: font-size:medium, ">Epidural analgesia； Primipara； Labor process； Pelvic floor function

中图分类号:

何玉花, 徐凤英, 吴华彬. 不同时机行硬膜外分娩镇痛对初产妇产程及早期盆底功能的影响[J]. 中国医药导刊, 2020, 22(11): 758-762.

HE Yuhua, XU Fengying, WU Huabin. Effects of Epidural Analgesia at Different Laboring Phases on Primipara Labor Progress and Early Postpartum Recovery of Pelvic Floor Function[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2020, 22(11): 758-762.

参考文献

[1]Gupta K， Mitra S， Kazal S， et al. Ⅳ. paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour： a randomized controlled study[J]. Br J Anaesth， 2016， 117 (5)：617-622.
     [2]张利平，李华，李引弟，等. 硬膜外分娩镇痛对单胎头位初产妇妊娠结局的影响[J]. 中华妇幼临床医学杂志(电子版)， 2017， 13 (3)：364-368.
     [3]宋丽，张英，周述芝，等. 硬膜外镇痛分娩对产程及胎儿血气的影响[J]. 实用医院临床杂志， 2014， 11(6)：110-112.
     [4]Woo JH， Kim JH， Lee GY， et al. The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome[J]. Korean J Anaesthesiology， 2015， 68(3)：249-253.
     [5]Fritel X. Pelvic floor and pregnancy[J]. Gynecol Obstet Fertil， 2010， 38(5)：332.
     [6]Gen Koyucu R， Demirci N， Ender Yumru A， et al. Effects of intradermal sterile water injections in women with low back pain in labor： a randomized， controlled， clinical trial[J]. Balkan Med J， 2018， 35(2)：148-154.
     [7]黄遐，杨娟，杨永秀. 分娩镇痛研究进展[J]. 国际妇产科学杂志， 2017， 44 (2)：197-201.
     [8]Plante L， Gaiser R. Practice Bulletin No. 177： Obstetric Analgesia and Anesthesia[J]. Obst Gynecol， 2017， 129(4)：e73-e89.
     [9]ngeby K， Sandin-Boj AK， Persenius M， et al. Women′s labour experiences and quality of care in relation to a prolonged latent phase of labour[J]. Midwifery， 2019， 77：155-164.
     [10]刘德来. 硬膜外麻醉分娩镇痛的临床研究[J]. 医疗装备， 2018， 31(5)：191-192.
     [11]Mattsson NK， Karjalainen PK， Tolppanen AM，et al. Pelvic organ prolapse surgery and quality of life-a nationwide cohort study[J]. Am J Obstet Gynecol， 2020， 222(6)：588.e1-e10.
     [12]Hoogenboom G， Thwin MM， Velink K， et al. Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border：a survey using WHO safe motherhood needs assessment [J]. BMC Pregnancy Childbirth， 2015， 5(15)：17.
     [13]吴方银，张燕，肖兵，等. 四川省非医学指征剖宫产现状分析[J]. 实用妇产科杂志， 2012， 28(3)：187-190.
     [14]Liu B， Wang Y， Xu H， et al. Effect of electroacupuncture versus pelvic floor muscle training plus solifenacin for moderate and severe mixed urinary incontinence in women： a study protocol [J]. BMC Complementary and Alternative Medicine， 2014， 15(14)：301.
     [15]翟利平，徐公元，邓爱华. 不同时机实施硬膜外镇痛分娩对母婴结局的影响[J]. 中国妇幼保健， 2017， 32(15)：3688-3690.
     [16]Sng BL， Leong WL， Zeng Y， et al. Early versus late initiation of epidural analgesia for labour[J]. Cochrane Database Syst Rev， 2014， 9 (10)：CD007238.
     [17]Morau E， Jaillet M， Storme B， et al. Does programmed intermittent epidural bolus improve childbirth conditions of nulliparous women compared with patient-controlled epidural analgesiad： a multicentre， randomised， controlled， triple-blind study[J]. Eur J Anaesthesiol， 2019， 36(10)：755-762.
     [18]余娟.潜伏期硬膜外分娩镇痛与活跃期硬膜外分娩镇痛对母婴的影响[J].中国妇幼保健， 2018， 33（24）：6043-6045.
     [19]吴淑芬. 第一产程潜伏期硬膜外分娩镇痛对自然分娩初产妇VAS评分及剖宫产率的影响[J]. 临床医药实践，2019， 28（5）：350-352.
     [20]李媚芳，文四成，张远军，等. 初产妇生产过程中连续硬膜外镇痛对其产后早期盆底功能的影响[J]. 国际麻醉学与复苏杂志， 2018， 39(12)：1106-1118.
     [21]麻睿骏，叶秋玉，章玲斌，等. 椎管内阻滞麻醉对经阴道分娩产妇产后盆底肌功能恢复的影响[J]. 中国性科学， 2016， 25(12)：109-111.
     [22]王洁静，赵晓，张米红. 盆底肌力筛查在促进产妇盆底功能恢复中的意义[J]. 内蒙古医学杂志， 2019， 51(１)：67-68.
     [23]秦丽艳. 产后盆底功能障碍性疾病的防治研究进度[J]. 中国妇幼保健， 2017， 32 (5)：1101-1104.

快速检索引用检索图表检索高级检索