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分娩期间使用硬膜外镇痛对母婴结局的影响。

Effects of Using Epidural Analgesia during Delivery on Maternal and Infant Outcomes.

作者信息

Shuai Fei, Jia Junxiang, Lin Peng

机构信息

Department of Anesthesiology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.

出版信息

Gynecol Obstet Invest. 2022;87(1):46-53. doi: 10.1159/000522330. Epub 2022 Mar 16.

Abstract

OBJECTIVES

The aim of the study was to estimate the impact of epidural analgesia (EA) during delivery on maternal and infant outcomes.

DESIGN

This was a prospective cohort study.

PARTICIPANTS

In total, 159 pregnant multiparas in Women and Children's Hospital, School of Medicine, Xiamen University from November 2019 to May 2020 were enrolled. Patients were divided into the EA group (n = 80) and no analgesia group (n = 79) based on the choice of the parturients.

METHODS

The duration of labor, levels of umbilical arterial blood gas (pH and partial pressure oxygen), visual analog score (VAS), and adverse events were evaluated to compare differences between the EA group and no analgesia group, respectively.

RESULTS

The duration of labor was prolonged in the entire labor (p = 0.002), and the first stage (p = 0.001) in the EA group compared with the no analgesia group. The second stage of labor and third stage of labor, levels of umbilical arterial blood gas, and 1-min Apgar score in neonates were similar in EA and no analgesia groups (All p > 0.05). After adjusting age, prepregnancy body mass index, and past and present medical history, the VAS was low in the EA group compared with the no analgesia group when the uterine orifice was completely open (odds ratio [OR] = 0.001, 95% confidence interval [CI]: 0.001-0.002), 8 h postdelivery (OR = 0.508, 95% CI: 0.264-0.977), and 24 h postdelivery (OR = 0.321, 95% CI: 0.167-0.617). EA increased the proportion of adverse events occurring 5 min postdelivery (χ2 = 10.137, p = 0.001), while decreased the proportion of adverse events occurring 24 h postdelivery (χ2 = 4.750, p = 0.029).

LIMITATIONS

In terms of the effects of EA on neonates, we only measured the 1-min Apgar score of neonates.

CONCLUSIONS

EA might be a reliable pain relief method for pregnant women. The results of our study might give a reference for the use of EA during delivery in clinic.

摘要

目的

本研究旨在评估分娩期间硬膜外镇痛(EA)对母婴结局的影响。

设计

这是一项前瞻性队列研究。

参与者

2019年11月至2020年5月,厦门大学医学院附属妇女儿童医院共纳入159例经产妇。根据产妇的选择,将患者分为EA组(n = 80)和非镇痛组(n = 79)。

方法

分别评估产程、脐动脉血气水平(pH值和氧分压)、视觉模拟评分(VAS)和不良事件,以比较EA组和非镇痛组之间的差异。

结果

与非镇痛组相比,EA组的总产程(p = 0.002)和第一产程(p = 0.001)延长。EA组和非镇痛组的第二产程、第三产程、脐动脉血气水平以及新生儿1分钟Apgar评分相似(所有p>0.05)。在调整年龄、孕前体重指数以及既往和当前病史后,当宫口全开时(比值比[OR]=0.001,95%置信区间[CI]:0.001-0.002)、产后8小时(OR = 0.508,95%CI:0.264-0.977)和产后24小时(OR = 0.321,95%CI:0.167-0.617),EA组的VAS低于非镇痛组。EA增加了产后5分钟不良事件的发生率(χ2 = 10.137,p = 0.001),而降低了产后24小时不良事件的发生率(χ2 = 4.750,p = 0.029)。

局限性

就EA对新生儿的影响而言,我们仅测量了新生儿的1分钟Apgar评分。

结论

EA可能是一种可靠的孕妇镇痛方法。我们的研究结果可能为临床分娩时使用EA提供参考。

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