Ramin S M, Gambling D R, Lucas M J, Sharma S K, Sidawi J E, Leveno K J
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School, Dallas, USA.
Obstet Gynecol. 1995 Nov;86(5):783-9. doi: 10.1016/0029-7844(95)00269-w.
To compare the effects of epidural analgesia with intravenous (IV) analgesia on the outcome of labor.
Thirteen hundred thirty women with uncomplicated term pregnancies and in spontaneous labor were randomized to be offered epidural bupivacaine-fentanyl or IV meperidine analgesia during labor.
Comparison of the allocation groups by intent to treat revealed a significant association between epidural allocation and operative delivery for dystocia. However, only 65% of each randomization group accepted the allocated treatment. Four hundred thirty-seven women accepted and received meperidine as allocated, and they were compared with 432 women accepting epidural allocation. Significant associations resulted between epidural administration and prolongation of labor, increased rate of oxytocin administration, chorioamnionitis, low forceps, and cesarean delivery. Because of the high rate of noncompliance with treatment allocation, a multifactorial regression analysis was performed on the entire cohort, and a twofold relative risk of cesarean delivery persisted in association with epidural treatment. The impact of epidural treatment on cesarean delivery was significant for both nulliparous and parous women (risk ratios 2.55 and 3.81, respectively). Epidural analgesia provided significantly better pain relief in labor than did parenteral meperidine.
Although labor epidural analgesia is superior to meperidine for pain relief, labor is prolonged, uterine infection is increased, and the number of operative deliveries are increased. A two- to fourfold increased risk of cesarean delivery is associated with epidural treatment in both nulliparous and parous women.
比较硬膜外镇痛与静脉镇痛对分娩结局的影响。
1330例足月单胎妊娠且自然分娩的产妇被随机分为两组，分别在分娩期间接受硬膜外布比卡因-芬太尼镇痛或静脉注射哌替啶镇痛。
按意向性分析比较分组情况，发现硬膜外镇痛组与因难产而行手术分娩之间存在显著关联。然而，每个随机分组中只有65%的产妇接受了分配的治疗。437名产妇接受并按分配接受了哌替啶治疗，将她们与432名接受硬膜外镇痛的产妇进行比较。硬膜外镇痛与产程延长、催产素使用率增加、绒毛膜羊膜炎、低位产钳助产及剖宫产之间存在显著关联。由于治疗分配的不依从率较高，对整个队列进行了多因素回归分析，硬膜外镇痛与剖宫产的相对风险仍为两倍。硬膜外镇痛对初产妇和经产妇剖宫产的影响均显著（风险比分别为2.55和3.81）。硬膜外镇痛在分娩时提供的疼痛缓解明显优于胃肠外给予的哌替啶。
虽然分娩时硬膜外镇痛在缓解疼痛方面优于哌替啶，但产程延长、子宫感染增加，手术分娩数量增多。初产妇和经产妇接受硬膜外镇痛后剖宫产风险增加2至4倍。
