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| 重度子痫前期产妇椎管内分娩镇痛与阴道试产分娩结局的相关性 |
| Predictive value of the effects of neuraxial analgesia on delivery outcome in puerpera with severe preeclampsia |
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| DOI：10.12089/jca.2021.02.005 |
| 中文关键词: 子痫前期 椎管内分娩镇痛 阴道试产 产程时间 |
| 英文关键词: Preeclapsia Neuraxial analgesia Trial of labor Labor process |
| 基金项目:首都医科大学附属北京妇产医院,北京妇幼保健院中青年学科骨干培养专项基金（fcyy201626） |
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| 中文摘要: |
目的 探讨椎管内分娩镇痛对重度子痫前期产妇进行阴道试产分娩结局和产程管理的影响。
方法 回顾性分析2018年1—12月住院分娩并进行阴道试产的重度子痫前期孕产妇137例，年龄18～45岁，ASA Ⅱ或Ⅲ级，根据是否接受椎管内分娩镇痛分为两组：分娩镇痛组（LA组，n=91）和非分娩镇痛组（NLA组，n=46）。采集产妇基线资料、最终分娩方式、产程时间、产后住院时间以及产程中缩宫素和降压药物使用情况。
结果 LA组器械助产率、剖宫产率以及缩宫素、降压药使用率明显高于NLA组，第一产程、第二产程、总产程时间明显长于NLA组（P<0.05或P＜0.01）。两组第三产程时间、产后住院时间差异无统计学意义。多因素Logistic回归分析显示，椎管内分娩镇痛与器械助产率、剖宫产率以及降压药物使用情况无明显相关性，但与产程时间、缩宫素使用存在相关性（P<0.05或P＜0.01），倾向于延长产程时间和增加缩宫素使用。
结论 椎管内分娩镇痛与重度子痫前期产妇阴道试产时中转剖宫产和增加器械助产无明显相关性。在提供高质量镇痛的前提下，椎管内分娩镇痛值得且可安全应用于接受阴道试产的重度子痫前期孕产妇。 |
| 英文摘要: |
Objective To investigate the effects of neuraxial analgesia on delivery outcome and labor process in puerpera with severe preeclampsia.
Methods A total of 137 patients with severe preeclampsia, aged 18-45 years, ASA physical status Ⅱ or Ⅲ, who were hospitalized for vaginal delivery from January to December, 2018 were retrospectively analyzed. According to whether they received neuraxial analgesia, they were divided into two groups: labor analgesia group (group LA, n = 91) and non-labor analgesia group (group NLA, n = 46). The basic demographic data, the delivery mode, the duration of labor, the length of hospital stay, the oxytocin and antihypertensive drug use during labor were analyzed.
Results The cesarean section rate, the instrumental delivery rate, and the proportion of patients using oxytocin and antihypertensive drugs were significantly higher in group LA than those in group NLA (P < 0.05). Meanwhile, the first stage, the second stage and the whole stage of labor in group LA were significantly longer than that in group NLA (P < 0.05 or P < 0.01). There was no significant difference in the length of the third stage of labor and the hospital stay between the two groups. Multivariate logistic regression analysis showed that there was no correlation among neuraxial analgesia and instrumental delivery rate, cesarean section rate and the use of antihypertentsive drugs, but it was correlated with the length of labor process and oxytocin use (P < 0.05 or P < 0.01), and tended to prolong the labor process and increase the use of oxytocin.
Conclusion There is no significant correlation between neuraxial analgesia and transition to cesarean delivery and instrumental delivery during vaginal delivery of women with severe preeclampsia. When providing high-quality analgesia, neuraxial analgesia is worthwhile and can be safely applied to pregnant women with severe preeclampsia. |
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