Ye Yuanjuan, Song Xingrong, Liu Lei, Shi Shao-Qing, Garfield Robert E, Zhang Guozheng, Liu Huishu
Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Department of Anesthesia, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Reprod Sci. 2015 Nov;22(11):1350-7. doi: 10.1177/1933719115578926. Epub 2015 Mar 29.
To investigate the effect of patient-controlled epidural analgesia (PCEA) on uterine electromyography (EMG) activity in term pregnant women during labor.
Nulliparous pregnant women in spontaneous term labor (N = 30) were enrolled (PCEA group, n = 20 and control group, n = 10). Five time periods (30 minutes each) were defined for noninvasive abdominal recordings and analysis of uterine EMG activity, that is, period I: before PCEA treatment with 2-cm cervical dilation; periods II to IV: each period successively at 30, 60, and 120 minutes after PCEA; and period V: second stage of labor with cervix at 10 cm dilation. Control patients without PCEA were monitored during the same times. The number of bursts/30 min, power density spectrum peak frequency, mean amplitude, and duration of uterine EMG bursts were measured to assess uterine EMG activity. Maternal, fetal, and labor characteristics were also recorded. Data were analyzed by analysis of variance followed by other tests.
Electromyography parameters are significantly lower (P < .001) after PCEA (periods II to IV) compared to controls but similar between groups by period V (P > .05). Also, patients with PCEA have a slower rate of cervical dilation (P < .003, period IV only) and longer labor in both stage 1 and stage 2 (P < .05). All patients have similar (P > .05) positive labor outcomes.
Patient-controlled epidural analgesia initially suppresses uterine EMG and slows cervical dilation thereby prolonging labor. However, the EMG activity recovers with labor progress with no effects on delivery outcomes.
探讨分娩期患者自控硬膜外镇痛（PCEA）对足月妊娠妇女子宫肌电图（EMG）活动的影响。
纳入足月自然分娩的初产妇（N = 30）（PCEA组，n = 20；对照组，n = 10）。定义五个时间段（每个时间段30分钟）用于无创腹部记录和分析子宫EMG活动，即：时间段I：宫颈扩张2 cm时，PCEA治疗前；时间段II至IV：PCEA后30、60和120分钟各一个时间段；时间段V：宫颈扩张至10 cm时的第二产程。同时对未接受PCEA的对照患者进行监测。测量子宫EMG爆发的次数/30分钟、功率密度谱峰值频率、平均幅度和持续时间，以评估子宫EMG活动。还记录产妇、胎儿和分娩特征。数据采用方差分析及其他检验进行分析。
与对照组相比，PCEA后（时间段II至IV）肌电图参数显著降低（P <.001），但在时间段V时两组间相似（P >.05）。此外，PCEA患者的宫颈扩张速度较慢（仅在时间段IV，P <.003），第一产程和第二产程的产程均较长（P <.05）。所有患者的分娩结局相似（P >.05）。
患者自控硬膜外镇痛最初会抑制子宫EMG并减缓宫颈扩张，从而延长产程。然而，随着产程进展，EMG活动会恢复，且对分娩结局无影响。
