Mizrachi Yossi, Leytes Sophia, Levy Michal, Ginath Shimon, Bar Jacob, Ezri Tiberiu, Kovo Michal
a Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv-Yafo , Israel.
b Department of Obstetrics and Gynecology , Edith Wolfson Medical Center , Holon , Israel.
J Matern Fetal Neonatal Med. 2018 Mar;31(5):586-590. doi: 10.1080/14767058.2017.1292500. Epub 2017 Feb 28.
To study whether meperidine analgesia affects the incidence of obstetric lacerations at normal vaginal deliveries.
A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. The incidence of various obstetric lacerations was compared between deliveries with meperidine analgesia and deliveries with no analgesia. Deliveries with epidural analgesia and instrumental deliveries were excluded. An intravenous infusion of 75 mg of meperidine was administered together with 25 mg of promethazine. A multivariate logistic regression analysis was performed to assess the association between meperidine analgesia and obstetric lacerations, after controlling for confounders.
Overall, 5227 (91.8%) deliveries with no analgesia and 466 (8.1%) deliveries with meperidine analgesia were included. Meperidine analgesia was associated with a decreased risk of first- and second-degree perineal lacerations (adjusted OR = 0.63, 95% CI = 0.49-0.81), and a decreased risk of any suturing (adjusted OR = 0.73, 95% CI = 0.59-0.91), after controlling for confounders. Meperidine analgesia did not affect the risk of severe perineal lacerations or episiotomies.
Meperidine analgesia may have a protective effect against first- and second-degree perineal lacerations.
研究哌替啶镇痛是否会影响正常阴道分娩时产科撕裂伤的发生率。
对2011年至2015年期间在一家三级医院进行正常阴道分娩的所有足月单胎头位妊娠妇女进行回顾性队列研究。比较使用哌替啶镇痛的分娩与未使用镇痛的分娩中各种产科撕裂伤的发生率。排除硬膜外镇痛分娩和器械助产分娩。静脉输注75毫克哌替啶并加用25毫克异丙嗪。在控制混杂因素后，进行多因素逻辑回归分析以评估哌替啶镇痛与产科撕裂伤之间的关联。
总体而言，纳入了5227例（91.8%）未使用镇痛的分娩和466例（8.1%）使用哌替啶镇痛的分娩。在控制混杂因素后，哌替啶镇痛与一、二度会阴撕裂伤风险降低相关（调整后的比值比=0.63，95%置信区间=0.49-0.81），与任何缝合风险降低相关（调整后的比值比=0.73，95%置信区间=0.59-0.91）。哌替啶镇痛不影响严重会阴撕裂伤或会阴切开术的风险。
哌替啶镇痛可能对一、二度会阴撕裂伤有保护作用。
