评价硬膜外镇痛在中期引产中的疗效和安全性：一项单中心、前瞻性、非随机、对照研究。
Evaluation efficacy and safety of epidural analgesia in second-trimester induced labor: A single-center, prospective, non-randomized, controlled study.
机构信息
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China.
出版信息
Medicine (Baltimore). 2022 Sep 23;101(38):e30767. doi: 10.1097/MD.0000000000030767.
BACKGROUND
Second-trimester induced labor in pregnant women was often more likely to suffer from psychological and physiological double pain. However, the analgesic management received less attention, and the optimal analgesic mode for second-trimester induced labor had not been determined. Our objective was to evaluate the feasible of epidural analgesia (EA) in second-trimester induced labor.
METHODS
From January 2020 to December 2021, Primipara who planned to undergo second-trimester induced labor in the First Affiliated Hospital of Yangtze University were collected. The method of labor induction was oral mifepristone + amniotic cavity injection of Ethacridine Lactate. Based on whether or not patients received epidural analgesia, which were divided into EA group (30 cases) and non-EA (NEA) group (30 cases). The primary outcome were visual analog scale (VAS) score of pain and result of follow-up, the secondary outcomes included relative clinical parameter and labor duration.
RESULTS
Vaginal induction of labor was successful in both groups. There was no statistically significant difference in VAS of pain between the two groups before analgesia (P > .05), but the VAS of pain in the EA group was significantly lower than the NEA group (P < .05) after analgesia or at delivery. The following outcomes showed no statistical difference between two groups: labor duration, postpartum hemorrhage, hemorrhage ≥ 500 mL, intrapartum injury, second days hemoglobin, C-reactive protein, antibiotic therapy days, hospitalizations days, and placenta residue (P > .05). The median hospitalization costs of EA group was 4697.5 yuan, and NEA group was 3673 yuan, the difference was statistically significant (P < .001). No adverse events related to EA occurred during hospitalization, only 3 patients showed mild lumbago and back pain after follow-up to three months postpartum, which was significantly relieved after proper rest.
CONCLUSION
EA can significantly reduce the pain of parturients, which may be effective and safe in the second-trimester induced labor.
背景
孕妇中期引产往往更容易遭受心理和生理的双重痛苦。然而，其镇痛管理受到的关注较少，也尚未确定中期引产的最佳镇痛模式。我们的目的是评估硬膜外镇痛（EA）在中期引产中的可行性。
方法
本研究收集了 2020 年 1 月至 2021 年 12 月期间在长江大学第一附属医院计划进行中期引产的初产妇。引产方法为口服米非司酮+乳酸依沙吖啶羊膜腔注射。根据患者是否接受硬膜外镇痛，将其分为 EA 组（30 例）和非-EA（NEA）组（30 例）。主要结局为疼痛的视觉模拟评分（VAS）和随访结果，次要结局包括相关临床参数和产程。
结果
两组均成功进行了阴道引产。在镇痛前，两组 VAS 疼痛评分无统计学差异（P＞.05），但镇痛后或分娩时 EA 组的 VAS 疼痛评分明显低于 NEA 组（P＜.05）。两组间产程、产后出血量、出血量≥500ml、产伤、产后第 2 天血红蛋白、C 反应蛋白、抗生素治疗天数、住院天数、胎盘残留无统计学差异（P＞.05）。EA 组的中位住院费用为 4697.5 元，NEA 组为 3673 元，差异有统计学意义（P＜.001）。住院期间未发生与 EA 相关的不良事件，仅 3 例在随访至产后 3 个月时出现轻度腰痛和背痛，适当休息后明显缓解。
结论
EA 可显著减轻产妇的疼痛，在中期引产中可能是有效且安全的。
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