第二产程和硬膜外使用：比先前建议的影响更大。
Second stage of labor and epidural use: a larger effect than previously suggested.
机构信息
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Department of Family Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania.
出版信息
Obstet Gynecol. 2014 Mar;123(3):527-535. doi: 10.1097/AOG.0000000000000134.
OBJECTIVE
To examine the length of second stage of labor with and without an epidural during labor.
METHODS
This was a retrospective cohort study of 42,268 women who delivered vaginally with normal neonatal outcomes. Median lengths and 95th percentiles of second stage of labor were compared by epidural use with stratification by parity. Statistical comparisons were performed using the Kruskal-Wallis test and Kaplan-Meier survival analysis.
RESULTS
Compared with women without epidural use, the 95th percentile length of second stage for nulliparous women was 197 minutes without epidural and 336 minutes with epidural (P<.001), a difference of 2 hours and 19 minutes. For multiparous women, the 95th percentile length of second stage was 81 minutes without epidural and 255 minutes with epidural (P<.001), a difference of 2 hours and 54 minutes.
CONCLUSION
Although recommendations for intervention during the second stage of labor have been made based on a 1-hour difference in the setting of epidural use, it appears that the 95th percentile duration is actually more than 2 hours longer with epidural during labor for both nulliparous and multiparous women.
目的
研究分娩时有无硬膜外麻醉对第二产程长度的影响。
方法
本研究为回顾性队列研究，共纳入 42268 名分娩且新生儿结局正常的阴道分娩产妇。根据产次分层，比较了硬膜外麻醉使用与不使用时第二产程的中位数和 95%分位数。采用 Kruskal-Wallis 检验和 Kaplan-Meier 生存分析进行统计学比较。
结果
与未使用硬膜外麻醉的产妇相比，初产妇中，无硬膜外麻醉时第二产程的 95%分位数为 197 分钟，有硬膜外麻醉时为 336 分钟（P<.001），相差 2 小时 19 分钟。对于经产妇，无硬膜外麻醉时第二产程的 95%分位数为 81 分钟，有硬膜外麻醉时为 255 分钟（P<.001），相差 2 小时 54 分钟。
结论
尽管在硬膜外麻醉使用的情况下，第二产程的干预建议基于 1 小时的差异，但对于初产妇和经产妇来说，分娩时使用硬膜外麻醉的 95%分位数时长似乎实际上要长 2 小时以上。
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