| 吴海红,余 洁,桑 琳,鲁大伟,王润秋.不同分娩镇痛时机对初产妇产程进展、母婴结局及早期盆底功能的影响[J].,2023,(3):551-554 |
| 不同分娩镇痛时机对初产妇产程进展、母婴结局及早期盆底功能的影响 |
| Effects of Different Labor Analgesia Timing on the Labor Progress, Maternal and Infant Outcomes and Early Pelvic Floor Function of Primiparas |
| 投稿时间：2022-05-18 修订日期：2022-06-14 |
| DOI：10.13241/j.cnki.pmb.2023.03.030 |
| 中文关键词: 分娩镇痛 初产妇 硬膜外阻滞 产程 潜伏期 母婴结局 盆底功能 |
| 英文关键词: Labor analgesia Primiparas Epidural block Labor Incubation period Maternal and infant outcomes Pelvic floor functional |
| 基金项目:安徽省高等学校省级质量工程项目（2017zhkt255） |
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| 中文摘要: |
| 摘要 目的：探讨不同分娩镇痛时机对初产妇产程进展、母婴结局及早期盆底功能的影响。方法：选择2019年4月至2022年8月我院收治的148例拟接受硬膜外分娩镇痛的产妇，按照随机数字表法分为两组。A组（74例）于宫口扩张≤2 cm开始分娩镇痛，B组（74例）于宫口扩张＞2 cm进行分娩镇痛。比较两组产程、宫口扩张全时间、催产素使用、疼痛、母婴结局、盆底肌电指标以及盆底障碍发生情况。结果：A组宫口扩张全时间、第一产程、第二产程、压力性尿失禁发生率低于B组（P＜0.05），催产素使用率、中转剖宫产率高于B组（P＜0.05）。A组给药30 min（T1）、60 min（T2）、宫口扩张7-8 cm（T3）、宫口扩张全（T4）视觉模拟评分法（VAS）评分均低于B组（P＜0.05）。A组Ⅰ类肌纤维肌电压、Ⅱ类肌纤维肌电压高于B组（P＜0.05），Ⅰ类肌纤维疲劳度绝对值、Ⅱ类肌纤维疲劳度绝对值低于B组（P＜0.05）。结论：宫口扩张≤2 cm实施硬膜外分娩镇痛，可降低分娩对女性盆底肌群的损伤；宫口扩张＞2 cm实施硬膜外分娩镇痛，中转剖宫产率、产程中催产素使用率相对较低，应结合产妇的个体情况，综合考虑利弊选择最佳的镇痛时机。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of different labor analgesia timing on the labor progress, maternal and infant outcomes and early pelvic floor function of primiparas. Methods: From April 2019 to August 2022, 148 parturients who planned to receive epidural labor analgesia in our Hospital were selected, and they were divided into two groups according to the random number table method. Group A (74 cases) began labor analgesia when the uterine opening was expanded less than or equal to 2 cm, and group B (74 cases) began labor analgesia when the uterine opening was expanded greater than 2 cm. The labor stage, the total time of uterine orifice opening, use of oxytocin, pain, maternal and infant outcomes, pelvic floor electromyographic indicators and pelvic floor disorders were compared between the two groups. Results: The total time of uterine orifice opening, the first stage of labor, the second stage of labor and the incidence of stress urinary incontinence in the group A were lower than those in the group B (P<0.05), the utilization rate of oxytocin, transit cesarean section rate were higher than those in the group B (P<0.05). The visual analog scale (VAS) scores in the group A at administration for 30 min (T1), 60 min (T2), uterine orifice opening 7-8 cm (T3) and total uterine orifice opening (T4) were lower than those in the group B(P<0.05), and the muscle fibromyovoltage type Ⅰ and the muscle fibromyovoltage type Ⅱ in the A group were higher than those in the group B(P<0.05), the absolute value of muscle fiber fatigue of type Ⅰ and the absolute value of muscle fiber fatigue of type Ⅱ were lower than those in the group B(P<0.05). Conclusion: Epidural labor analgesia with uterine orifice dilation less than or equal to 2 cm can reduce the damage of female pelvic floor muscles during labor. Epidural labor analgesia with uterine orifice dilation greater than 2 cm has a relatively low transit cesarean section rate and the utilization rate of oxytocin during labor. The best time for analgesia should be selected by considering the advantages and disadvantages in combination with the individual situation of pregnant women. |
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