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目的:研究在产程潜伏期及活跃期实施腰硬联合阻滞麻醉分娩镇痛对分娩方式、剖宫产指征、缩宫素使用情况、产程时间、产后出血量、新生儿Apgar评分的影响。方法:选择2 000例初产妇,根据实施分娩镇痛时宫口扩张情况分为潜伏期组(A组)1 000例,活跃期组(B组)1 000例。另选未行分娩镇痛的初产妇1 000例为对照组(C组)。比较三组产妇的分娩方式、剖宫产指征、缩宫素使用情况、产程时间、产后出血量、新生儿Apgar评分。结果:A组和B组剖宫产率比C组低,差异有统计学意义(P<0.05);A组和B组缩宫素使用比C组高,差异有统计学意义(P<0.05)。三组在产程时间、产后出血量、新生儿Apgar评分方面比较差异无统计学意义(P>0.05)。剖宫产指征前3位A组依次为活跃期停滞、第二产程停滞、胎儿窘迫;B组依次为第二产程停滞、活跃期停滞、胎儿窘迫;C组依次为胎儿窘迫、活跃期停滞、第二产程停滞。C组因胎儿窘迫改行剖宫产的比例明显高于A组和B组,差异有统计学意义(P<0.05),A组和B组因活跃期停滞、第二产程停滞改行剖宫产的比例明显高于C组,差异有统计学意义(P<0.05)。结论:无论在潜伏期或活跃期实施分娩镇痛均不影响产程时间、产后出血量、新生儿Apgar评分。实施分娩镇痛能降低剖宫产率,但会增加缩宫素的使用。
OBJECTIVE: To study the effect of labor analgesia combined with lumbar epidural anesthesia on labor mode, indication of cesarean section, use of oxytocin, duration of labor, postpartum hemorrhage volume and neonatal Apgar score during labor latency and active phase. Methods: A total of 2 000 primipara were selected. According to the dilatation of cervix during labor analgesia, 1 000 cases were divided into latent period (A group) and 1 000 active period (B). Another 1000 cases of primipara without labor analgesia as control group (C group). The mode of delivery, the indication of cesarean section, the use of oxytocin, the duration of labor, the amount of postpartum hemorrhage and the Apgar score of neonates were compared among the three groups. Results: The rate of cesarean section in group A and group B was lower than that in group C (P <0.05). The use of oxytocin in group A and group B was higher than that in group C (P <0.05 ). There was no significant difference between the three groups in terms of labor duration, postpartum hemorrhage, and neonatal Apgar score (P> 0.05). The first 3 groups of cesarean indications followed by active phase arrest, the second stage of labor stagnation, fetal distress; B followed by the second stage of labor stagnation, active arrest, fetal distress; C followed by fetal distress, active stagnation , The second stage of labor stagnation. In group C, the proportion of cesarean section due to fetal distress was significantly higher than that of group A and B (P <0.05), group A and group B were delayed due to active stage, and the second stage of labor was delayed to cesarean section The proportion was significantly higher than C group, the difference was statistically significant (P <0.05). CONCLUSION: Labor analgesia did not affect labor duration, postpartum hemorrhage, and neonatal Apgar score, both in incubation period and in active phase. Delivery analgesia can reduce cesarean section rate, but will increase the use of oxytocin.