目的 基于快速康复理念，探讨低浓度硬膜外镇痛联合产后早期膀胱区低频脉冲电刺激对高龄经阴道分娩产妇满意度及下尿路功能的影响。 方法 采用前瞻性随机对照研究，选取2023年6月至2025年6月在无锡市妇幼保健院行硬膜外镇痛经阴道分娩的高龄产妇120例，按随机数字表法分为A组（常规浓度硬膜外镇痛）、B组（低浓度硬膜外镇痛）、C组（常规浓度硬膜外镇痛+产后早期膀胱区低频脉冲电刺激）和D组（低浓度硬膜外镇痛+产后早期膀胱区低频脉冲电刺激），每组30例。比较4组产妇满意度、产后尿潴留（PUR）、导尿率、首次排尿时间、膀胱残余尿量（PVR）、完全自主排尿时间、泌尿系统感染（UTI）发生率及产后6、24、48、72 h疼痛视觉模拟评分（VAS）。 结果 4组补救镇痛发生率和舒芬太尼总用量比较差异无统计学意义（P 0.05），低浓度镇痛组罗哌卡因总用量低于常规浓度镇痛组（P 0.001）。4组满意度评分、住院时间比较差异有统计学意义（P 0.01），D组满意度最高、住院时间最短。4组PUR发生率、导尿率、首次排尿时间、PVR、完全自主排尿时间及UTI发生率比较差异均有统计学意义（P 0.05），其中D组下尿路功能恢复最佳。4组复合不良泌尿结局发生率比较差异有统计学意义（P 0.01），D组最低。4组产后6、24 h VAS评分比较差异无统计学意义（P 0.05），产后48、72 h VAS评分比较差异有统计学意义（P 0.01），C组和D组低于A组和B组。 结论 在相同基础ERAD管理基础上，低浓度硬膜外镇痛联合产后早期膀胱区低频脉冲电刺激可提高高龄经阴道分娩产妇满意度，降低产后尿潴留、导尿及泌尿系统感染相关风险，促进下尿路功能恢复。

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.