多产妇分娩时使用与不使用硬膜外镇痛的效果比较：一项回顾性病例对照研究。

Labor epidural analgesia versus without labor epidural analgesia for multiparous women: a retrospective case control study.

机构信息

Department of Anesthesiology, Shandong Province Maternal and Child Health Care Hospital, 238 East Road of Jingshi, Jinan, Shandong, P.R. China.

Department of Gynaecology and Obstetrics, Shandong Province Maternal and Child Health Care Hospital, 238 East Road of Jingshi, Jinan, Shandong, P.R. China.

出版信息

BMC Anesthesiol. 2021 Apr 28;21(1):133. doi: 10.1186/s12871-021-01355-0.

DOI:10.1186/s12871-021-01355-0

PMID:33910504

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8080314/

Abstract

BACKGROUND

Labor epidural analgesia (LEA) effectively relieves the labor pain, but it is still not available consistently for multiparous women in many institutions because of their obviously shortened labor length.

METHODS

A total of 811 multiprous women were retrospective enrolled and firstly divided into two groups: LEA group or non-LEA group. And then they were divided into seven subgroups and analyzed according to the use of LEA and cervical dilation. The primary outcomes (time intervals, blood loss and Apgar scores) and secondary outcomes (maternal demographic characteristics and birth weight) were collected by checking electronic medical records.

RESULTS

The prevalence of using LEA in multiprous women was 54.5 %. Using LEA significantly lengthened the duration of labor stage by 56 min (P < 0.001), increased the blood loss (P < 0.001) and lowered Apgar scores (P = 0.001). In the comparison of sub-group analysis, using LEA can obviously prolong the duration of first-second stage in women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.014), while there was no significant difference with 4 cm or more cervical dilation (P = 0.69). Using LEA can significantly increased the blood loss when the initiation of LEA in the women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.035), meanwhile there were no significantly differences in the women with 4 cm or more cervical dilation (P = 0.524). Using LEA can significantly lower the Apgar scores when the initiation of LEA in the women with 2 cm cervical dilation (P = 0.001) and 4 cm or more cervical dilation (P = 0.025), while there were no significantly differences in the women with 3 cm cervical dilation (P = 0.839).

CONCLUSIONS

Labor epidural analgesia for the multiparous woman may alter progress of labor, increase postpartum blood loss and lower Apgar scores. Early or late initiation of LEA should be defined as with cervical dilatation of less or more than 3 cm and the different effect should be understand.

TRIAL REGISTRATION

ChiCTR2100042746. Registered 27 January 2021-Prospectively registered, http://www.chictr.org.cn .

摘要

背景

分娩硬膜外镇痛（LEA）能有效缓解分娩疼痛，但由于许多机构中经产妇的产程明显缩短，其应用仍不普及。

方法

回顾性纳入 811 例经产妇，首先分为 LEA 组和非-LEA 组。然后根据 LEA 的使用情况和宫颈扩张情况将其分为 7 个亚组进行分析。通过查阅电子病历收集主要结局（时间间隔、出血量和 Apgar 评分）和次要结局（产妇人口统计学特征和出生体重）。

结果

经产妇中 LEA 的使用率为 54.5%。使用 LEA 可使第一产程和第二产程的时间分别延长 56 分钟（P<0.001），增加出血量（P<0.001），降低 Apgar 评分（P=0.001）。在亚组分析比较中，LEA 可明显延长 2cm 宫颈扩张（P<0.001）和 3cm 宫颈扩张（P=0.014）的产妇的第一产程和第二产程时间，而对 4cm 或更大宫颈扩张的产妇无显著差异（P=0.69）。LEA 在 2cm 宫颈扩张（P<0.001）和 3cm 宫颈扩张（P=0.035）的产妇中启动时会显著增加出血量，但在 4cm 或更大宫颈扩张的产妇中无显著差异（P=0.524）。LEA 在 2cm 宫颈扩张（P=0.001）和 4cm 或更大宫颈扩张（P=0.025）的产妇中启动时会显著降低 Apgar 评分，而在 3cm 宫颈扩张的产妇中无显著差异（P=0.839）。