关键词: 高龄产妇, 硬膜外镇痛, 低频脉冲电刺激, 产后尿潴留, 下尿路功能

Abstract:

Objective To investigate the effects of low-concentration epidural analgesia combined with early postpartum bladder low-frequency pulsed electrical stimulation on maternal satisfaction and lower urinary tract function in advanced maternal age parturients undergoing vaginal delivery under an enhanced recovery after delivery pathway. Methods A prospective randomized controlled study was carried out on 120 parturients aged 35 years or older who received vaginal delivery with epidural analgesia at Wuxi Maternal and Child Health Hospital from June 2023 to June 2025. These parturients were randomly divided into four groups： Group A （conventional-concentration epidural analgesia）， Group B （low-concentration epidural analgesia）， Group C （conventional-concentration epidural analgesia plus early bladder low-frequency pulsed electrical stimulation）， and Group D （low-concentration epidural analgesia plus early bladder low-frequency pulsed electrical stimulation）， with 30 cases in each group. Comparisons were made among the four groups regarding maternal satisfaction， postpartum urinary retention （PUR）， catheterization rate， time to first voiding， post-void residual volume （PVR）， time to complete spontaneous voiding， urinary tract infection （UTI）， and visual analogue scale （VAS） scores at 6， 24， 48， and 72 h postpartum. Results There were no significant differences in the rescue analgesia rate or the total sufentanil dose among the four groups. However， the total ropivacaine dose was lower in the low-concentration groups. Maternal satisfaction scores and the length of stay differed significantly among the four groups （both P 0.01）， and group D exhibited the highest satisfaction and the shortest length of stay. Significant differences were also noted in the incidence of PUR， the catheterization rate， the time to first voiding， PVR， the time to complete spontaneous voiding， and UTI among the four groups （all P 0.05）， with group D demonstrating the best recovery of lower urinary tract function. The incidence of composite adverse urinary outcomes differed significantly among the four groups （P 0.01）， and the lowest incidence was observed in group D. No significant differences in VAS scores were detected at 6 h or 24 h postpartum （both P 0.05）， while significant differences were identified at 48 h and 72 h postpartum （both P 0.01）， and the scores in groups C and D were lower than those in groups A and B. Conclusions Under the same basic enhanced recovery after delivery management， the combination of low-concentration epidural analgesia and early postpartum bladder low-frequency pulsed electrical stimulation may enhance maternal satisfaction， reduce urinary complications， and facilitate the recovery of lower urinary tract function in advanced maternal age parturients undergoing vaginal delivery.

Key words: advanced maternal age, epidural analgesia, low-frequency pulsed electrical stimulation, postpartum urinary retention, lower urinary tract function