不同时机实施腰硬联合麻醉对初产妇分娩镇痛效果及满意度的影响

doi:10.3969/j.issn.1006-5725.2023.19.013

Abstract

Abstract:

Objective To compare the clinical effects of combined spinal epidural anesthesia （CSEA） at different times on the analgesic effect and satisfaction of primipara. Methods 504 primipara were included in this study. According to different degrees of cervical dilatation， the primipara with CSEA were divided into： Group Ⅰ （from labor to cervical dilation < 2 cm， n = 112 cases）， group Ⅱ （2 cm ≤ Cervical dilation < 5 cm， n = 176 cases）， group Ⅲ （cervix dilation ≥ 5 cm， n = 111 cases）， control group （no neuraxial anesthesia for labor analgesia， n = 105 cases）， in order to compare the effect of labor analgesia and satisfaction at different groups. Results The visual analogue scale （VAS） scores for group Ⅰ and group Ⅱ exceeded 3 points after 4 hours of labor analgesia， while the VAS scores for group Ⅲ exceeded 3 points after 3 hours of labor analgesia. The incubation period and the duration of the second stage of labor in group Ⅰ and group Ⅱ were longer than those in group Ⅲ and control group （all P < 0.05）. The incidence of uterine atony in group Ⅰ， group Ⅱ and group Ⅲ were higher than those in the control group （all P < 0.05）. The incidence of fever and urinary retention in group Ⅰ， group Ⅱ and group Ⅲ were higher than that in control group （all P < 0.05）. The satisfaction levels of primiparous women in group Ⅰ and group Ⅱ were significantly higher than those in group Ⅲ and control group （all P > 0.05）. Conclusion CSEA can effectively relieve pain for primiparous women after labor until the cervix is fully dilated. However， 4 hours after CSEA within 5 cm of the cervix， 3 hours after CSEA for cervix dilation larger than 5 cm， the anesthetic dose should be adjusted in time according to the pain score to achieve effective analgesia. It is important to observe and treat side effects related to anesthesia drugs in a timely manner to improve the satisfaction of primiparous women.

Key words: labor analgesia, analgesic timing, maternal and infant outcomes, anesthetic drug doses, satisfaction

CLC Number:

Minli HUANG,Zijing ZHANG,Hongfei DAI,Jiaxin LI,Shuzhen WU,Changping FANG,Zuen LIN,Lingling. WU. Effects and satisfaction of combined spinal epidural anesthesia at different time points on labor analgesia in primiparous women[J]. The Journal of Practical Medicine, 2023, 39(19): 2489-2494.

Figures/Tables 5

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References 26

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项目	Ⅰ组（n = 112）	Ⅱ组（n = 176）	Ⅲ组（n = 111）	对照组（n = 105）	F值	P值
年龄（岁）	29.06 ± 3.56	28.35 ± 3.34	28.30 ± 2.89	28.08 ± 3.41	1.858	0.136
孕前BMI（kg/m²）	20.55 ± 2.64	19.91 ± 2.08	20.17 ± 2.88	19.80 ± 2.36	1.860	0.136
孕次（次）	1.31 ± 0.59	1.30 ± 0.60	1.26 ± 0.50	1.05 ± 1.36	0.538	0.656
孕周（周）	39.49 ± 1.08	39.41 ± 1.13	39.19 ± 1.21	39.42 ± 0.93	1.581	0.193
新生儿体质量（kg）	3.17 ± 0.35	3.16 ± 0.34	3.11 ± 0.38	3.10 ± 0.38	1.230	0.298

项目	Ⅰ组		Ⅱ组		Ⅲ组		对照组		F值	P值
项目	例数	VAS	例数	VAS	例数	VAS	例数	VAS	F值	P值
镇痛前	112	7.55 ± 1.97	176	7.57 ± 1.58	111	7.97 ± 1.64	105	7.56 ± 1.15	1.874	0.133
镇痛后30 min	112	0.87 ± 1.11^ab	176	1.24 ± 1.28^ab	111	1.82 ± 1.88^a	105	7.60 ± 1.20	568.006	0.001
镇痛后1 h	112	0.88 ± 1.16^ab	175	1.42 ± 1.40^ab	107	2.02 ± 1.81^a	105	7.71 ± 1.32	541.214	0.001
镇痛后2 h	103	1.47 ± 1.66^ab	162	1.93 ± 1.60^ab	78	2.85 ± 2.29^a	105	8.17 ± 1.05	385.447	0.001
镇痛后3 h	100	2.40 ± 1.91^a	133	2.79 ± 1.67^a	36	3.33 ± 2.14^a	105	8.25 ± 0.99	291.462	0.001
镇痛后4 h	87	3.44 ± 2.42^a	116	3.94 ± 1.65^a	18	4.17 ± 2.43^a	105	8.61 ± 0.92	180.017	0.001
宫口开全时	112	6.51 ± 2.32^ab	176	6.56 ± 2.37^ab	111	5.14 ± 2.57^a	105	8.92 ± 1.14	54.439	0.001
分娩时	112	6.56 ± 2.23^ab	176	6.65 ± 2.36^ab	111	5.25 ± 2.58^a	105	9.06 ± 1.06	56.879	0.001

项目	Ⅰ组		Ⅱ组		Ⅲ组		F值	P值
项目	例数	药物剂量	例数	药物剂量	例数	药物剂量	F值	P值
镇痛后30 min	112	6	175	6	107	6
镇痛后1 h	112	6.21 ± 1.30^a	175	7.08 ± 4.68^a	107	8.21 ± 6.32	5.168	0.006
镇痛后2 h	103	6.80 ± 4.12^a	162	7.74 ± 5.51^a	78	10.16 ± 8.36	7.550	0.001
镇痛后3 h	100	8.02 ± 5.59^a	133	9.05 ± 7.52^a	36	11.50 ± 9.52	3.402	0.049
镇痛后4 h	84	10.33 ± 6.60	116	13.03 ± 9.96	18	10.44 ± 8.77	2.595	0.077
宫口开全时	112	12.43 ± 8.38	175	11.02 ± 9.92	107	9.96 ± 7.69	2.148	0.118
分娩时	112	7.93 ± 5.50	175	8.56 ± 8.17	107	7.15 ± 4.93	1.520	0.220

项目	I组（n = 112）	Ⅱ组（n = 176）	Ⅲ组（n = 111）	对照组（n = 105）	χ²/F值	P值
潜伏期（h）	9.12 ± 3.70^ab	9.50 ± 4.13^ab	6.86 ± 3.85	6.94 ± 3.77	16.449	0.001
活跃期（h）	1.84 ± 1.00^a	2.06 ± 1.08^a	2.09 ± 1.10^a	1.21 ± 0.99	17.563	0.001
第二产程（h）	1.42 ± 1.16^ab	1.44 ± 0.98^ab	1.14 ± 0.75	1.07 ± 0.96	4.791	0.003
阴道助产率［例（%）］	6（5.4）	14（8.0）	3（2.7）	5（4.8）	3.787	0.285
产后出血率［例（%）］	9（8.0）	11（6.2）	6（5.4）	5（4.8）	1.150	0.765
脐动脉pH值	7.25 ± 0.84	7.23 ± 0.81	7.21 ± 0.45	7.24 ± 0.07	0.647	0.585
脐动脉剩余碱	-5.18 ± 2.72	-5.28 ± 2.71	-4.54 ± 2.65	-4.38 ± 3.11	2.546	0.056
脐动脉乳酸	4.99 ± 1.68	4.95 ± 1.96	4.59 ± 1.47	5.21 ± 2.03	1.835	0.137
1 min Apgar（分）	9.93 ± 0.44	9.93 ± 0.31	9.99 ± 0.10	9.92 ± 0.45	0.928	0.427
5 min Apgar（分）	10.00	10.00	10.00	10.00
宫缩乏力［例（%）］	57（50.9）^abc	60（34.3）^a	42（37.8）^a	9（8.6）	45.550	0.001
发热［例（%）］	35（31.2）^ab	55（31.2）^ab	15（13.5）^a	2（1.9）	44.692	0.001
尿潴留［例（%）］	53（47.3）^ab	67（38.1）^ab	31（27.9）	29（27.6）	12.925	0.005

项目	满意度	满意度≤ 3分	镇痛效果欠佳	产程延长	麻醉药物副作用
Ⅰ组	4.61 ± 0.66^ab	14（12.5）^ab	11（9.7）^ab	1（0.9）	2（1.8）
Ⅱ组	4.44 ± 0.68^ab	25（14.2）^ab	18（10.2）^ab	4（2.3）	3（1.7）
Ⅲ组	4.14 ± 0.81^a	30（27.0）^ab	28（25.2）^ab	1（0.9）	1（0.9）
对照组	3.31 ± 0.75	66（62.9）^ab	64（61.0）^ab	2（1.9）	0（0）
χ²/F值	71.320	95.529	109.730	1.278	2.007
P值	0.001	0.001	0.001	0.734	0.557

Effects and satisfaction of combined spinal epidural anesthesia at different time points on labor analgesia in primiparous women

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