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中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 179 -183. doi: 10.3877/cma.j.issn.2095-3259.2021.03.012

论著

椎管内分娩镇痛对瘢痕子宫阴道分娩的影响
吴晓1, 岳永飞1, 黎婷1, 汪云1, 曲云1,†()   
  1. 1. 215002　苏州，南京医科大学附属苏州医院　苏州市立医院妇产科
  • 收稿日期:2020-12-24 出版日期:2021-08-18
  • 通信作者: 曲云
  • 基金资助:
    苏州市2020年度科技发展计划(SYSD2020133); 苏州市2017年度第十九批产业技术创新专项（民生科技）项目(SS201710)

The impact of intraspinal analgesia on trial of labor after cesarean section

Xiao Wu1, Yongfei Yue1, Ting Li1, Yun Wang1, Yun Qu1,†()   

  1. 1. Department of Obstetrics and Gynecology, Suzhou Municipal Hospital, Suzhou 215002, China
  • Received:2020-12-24 Published:2021-08-18
  • Corresponding author: Yun Qu
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吴晓, 岳永飞, 黎婷, 汪云, 曲云. 椎管内分娩镇痛对瘢痕子宫阴道分娩的影响[J]. 中华产科急救电子杂志, 2021, 10(03): 179-183.

Xiao Wu, Yongfei Yue, Ting Li, Yun Wang, Yun Qu. The impact of intraspinal analgesia on trial of labor after cesarean section[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(03): 179-183.

目的

探讨实施椎管内分娩镇痛对瘢痕子宫阴道分娩产程以及母儿结局的影响。

方法

回顾性分析2017年1月至2020年6月在我院定期产检并住院分娩的221例瘢痕子宫患者的临床资料，其中行椎管内分娩镇痛110例，未行椎管内分娩镇痛111例。统计研究对象的一般情况，比较椎管内分娩镇痛对瘢痕子宫阴道分娩的产程及母儿结局影响。

结果

两组研究对象的年龄、体重指数、孕周、产时出血量、新生儿体重和分娩前住院时间均无统计学差异(P>0.05)；镇痛组第一产程时间[(379.35±145.85)min]明显大于无镇痛组[(334.61±150.65)min](P＝0.012)，第二产程时间镇痛组[(63.57±26.20)min]明显大于无镇痛组[(54.61±27.32)min](P＝0.002)；人工破膜率镇痛组[27例(24.55%)]高于无镇痛组[14例(12.61%)](P＝0.023)；缩宫素催产率镇痛组[33例(30.00%)]高于无镇痛组[20例(18.02%)](P＝0.037)；中转剖宫产率无镇痛组[14例(12.61%)]高于镇痛组[5例(4.55%)]，差异具有统计学意义(P＝0.032)；产时发热率镇痛组[18例(16.36%)]明显高于无镇痛组[7例(6.31%)]，差异具有统计学意义(P＝0.018)；两组间的1和5 min Apgar评分、新生儿窒息率、会阴Ⅱ度裂伤、产后出血和产妇产后腰痛率差异均无统计学意义(P>0.05)。

结论

瘢痕子宫阴道分娩孕妇实施椎管内分娩镇痛可以明显缓解疼痛并降低阴道试产的中转剖宫产率，第一和第二产程时间可能会延长，但并不影响母儿分娩结局，是一种安全有效的分娩镇痛方式。

关键词: 剖宫产后阴道分娩, 镇痛，产科, 妊娠结局
Objective

To investigate the effect of intraspinal analgesia on vaginal delivery of scar uterus and the outcome of mother and child.

Methods

221 patients with scar uterus, which included 110 pregnant women receiving intraspinal delivery analgesia and 111 pregnant women without receiving intraspinal delivery analgesia, were retrospectively analyzed in our hospital from January 2017 to June 2020. The general conditions of the subjects were statistically analyzed. The effects of analgesia in spinal canal delivery on the labor process and the outcomes of mother and child during vaginal delivery with scar uterus were compared.

Results

There were no significant differences in age, body mass index (BMI), gestational age, blood loss at birth, neonatal weight and hospitalization time before delivery comparing in the two groups (P>0.05). The first stage of labor in scar uterine analgesia group [(379.35±145.85)min] were significantly statistically longer than those in scar uterine without analgesia group [(334.61±150.65)min] (P=0.012). The second stage of labor in scar uterine analgesia group [(63.57±26.20)min] were significantly longer than those in scar uterine without analgesia group [(54.61±27.32)min] (P=0.002). There were no significant differences in the third stage of labor, perineal lateral resection and vaginal midwifery rates between the two groups (P>0.05). The artificial rupture of fetal membrane rate in scar uterine analgesia group [27 cases(24.55%)] was significantly higher than in scar uterine without analgesia group [14 cases(12.61%)] (P=0.023). The oxytocin usage rate in scar uterine analgesia group [33 cases(30%)] was significantly higher than that in scar uterine without analgesia group [20 cases(18.02%)] (P=0.037). The conversion rate of cesarean section in the group without scar uterus analgesia [14 cases(12.61%)] was significantly higher than that in scar uterus analgesia group [5 cases(4.55%)] (P=0.032). The conversion rate of intrapartum fever in scar uterus analgesia group [18 cases(16.36%)] was significantly higher than that in the group without scar uterus analgesia [7 cases(6.31%)] (P=0.018). There were no significant differences in 1-minute Apgar score, 5-minute Apgar score, neonatal asphyxia rate, perineal Ⅱ degree lacerations, postpartum hemorrhage and postpartum low back pain rate between the two groups (P>0.05).

Conclusions

Intraspinal analgesia can significantly relieve pain and reduce cesarean section rate during vaginal birth after cesarean. The duration of the first and second labor may be prolonged, but it does not affect the outcome of mother and child delivery. It is a safe and effective method for childbirth analgesia.

Key words: Vaginal birth after cesarean, Analgesia, obstetrical, Pregnancy outcome
表1 两组患者一般临床资料比较(±s)
组别 例数 年龄(岁) BMI(kg/m2) 孕周(周) 产时出血量(ml) 新生儿体重(g) 分娩前住院时间(min)
瘢痕子宫镇痛组 110 28.10±3.99 20.60±2.45 39.19±1.06 251.70±87.70 3355.00±402.97 763.32±287.83
瘢痕子宫无镇痛组 111 27.42±3.45 20.66±2.89 38.99±1.37 247.82±61.99 3353.60±472.70 720.54±242.86
统计值   t＝1.366 t＝0.162 t＝1.232 t＝-0.287 t＝0.024 Z＝-1.365
P值   0.173 0.871 0.219 0.774 0.981 0.172
表2 两组研究对象的产程及分娩结局
组别 例数 第一产程(min, ±s) 第二产程(min, ±s) 第三产程(min, ±s) 人工破膜[例(%)] 缩宫素催产[例(%)] 会阴侧切[例(%)] 阴道助产[例(%)] 中转剖宫产[例(%)]
瘢痕子宫镇痛组 110 379.35±145.85 63.57±26.20 10.34±6.32 27(24.55) 33(30.00) 34(30.91) 9(8.18) 5(4.55)
瘢痕子宫无镇痛组 111 334.61±150.65 54.61±27.32 11.36±8.19 14(12.61) 20(18.02) 26(23.42) 6(5.41) 14(12.61)
统计值   t＝-2.515 t＝-3.090 Z＝-0.139 χ2＝5.206 χ2＝4.351 χ2＝1.565 χ2＝0.673 χ2＝4.576
P值   0.012 0.002 0.890 0.023 0.037 0.211 0.412 0.032
表3 两组研究对象的并发症及新生儿结局
组别 例数 Apgar评分(1 min, ±s) Apgar评分(5 min, ±s) 新生儿窒息[例(%)] 产时发热[例(%)] 会阴Ⅱ度裂伤[例(%)] 产后出血[例(%)] 产妇产后腰痛[例(%)] 子宫破裂[例(%)]
瘢痕子宫镇痛组 110 9.88±0.42 9.91±0.35 1(0.91) 18(16.36) 1(0.91) 4(3.64) 15(13.64) 1(0.090)
瘢痕子宫无镇痛组 111 9.86±0.54 9.94±0.28 1(0.90) 7(6.31) 3(2.70) 2(1.80) 13(11.71) 0(0.00)
统计值   t＝0.727 t＝1.735 χ2＝0.001 χ2＝5.570 χ2＝1.000 χ2＝0.704 χ2＝0.185 χ2＝1.014
P值   0.395 0.189 0.995 0.018 0.317 0.401 0.667 0.314
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