椎管内镇痛在瘢痕子宫阴道分娩中的应用与效果

林淑芬 康秀兰 吴惠琛

[摘要]目的探讨椎管内镇痛在瘢痕子宫阴道分娩中的应用与效果。方法选择广东医科大学顺德妇女儿童医院（佛山市顺德区妇幼保健院）在2019年1月至2020年12月收治的70例瘢痕子宫产妇为研究对象，依照是否采取镇痛措施分成两组。其中35例瘢痕子宫采用椎管内镇痛为观察组，另外35例瘢痕子宫不采取镇痛措施為对照组，比较两组产妇的第1产程、第2产程、疼痛情况以及分娩结局。结果观察组第1产程时间和第2产程时间均显著少于对照组，差异有统计学意义（ P <0.05）;观察组自然分娩率为94.29%，明显高于对照组的85.00%，转剖宫产率为5.71%明显低于对照组，差异有统计学意义（ P <0.05）;随着产程的进展，观察组实施镇痛后 VAS 评分显著低于对照组，差异有统计学意义（ P <0.05）。结论瘢痕子宫产妇采用椎管内镇痛，不仅能减轻分娩疼痛，而且能加快产程进展，降低转剖宫产率，值得推广应用。

[关键词]椎管内镇痛;瘢痕子宫;阴道分娩;产程时间;分娩结局;镇痛效果

[中图分类号] R714.3 [文献标识码] A  [文章编号]2095-0616（2021）22-0083-04

Application and effect of intraspinal analgesia in vaginal delivery of parturients with cicatricial uterus

LIN  Shufen   KANG  Xiulan   WU  Huichen

Delivery Room， Shunde Women and Children's Hospital of Guangdong Medical University （Maternal and Child Healthcare Hospital of Shunde District of Foshan City）， Guangdong， Foshan 528300， China

[Abstract] Objective To explore the application and effect of intraspinal analgesia in vaginal delivery of parturients with cicatricial uterus. Methods A total of 70 parturients with cicatricial uterus treated in Shunde Women and Children's Hospital of Guangdong Medical University （Maternal and Child Healthcare Hospital of Shunde District of Foshan City） from January 2019 to December 2020 were selected as the research objects， and were divided into two groups according to whether analgesic measures were taken or not.35 patients with cicatricial uterus who were treated with intraspinal analgesia were selected as the observation group， and the other 35 patients with cicatricial uterus who did not treated with analgesia were selected as the control group. The first stage of labor， the second stage of labor， pain and delivery outcomes of the two groups were compared. Results The first stage of labor and the second stage of labor in the observation group were significantly shorter than those in the control group， with statistically significant differences （P <0.05）. The natural delivery rate in observation group was 94.29%， which was significantly higher than that in control group （85.00%）， and the rate of conversion to cesarean section was 5.71%， which was significantly lower than that in control group， with statistically significant differences （P <0.05）. With the progress of labor， the Visual Analogue Scale （VAS） score of the observation group Lower than that in the control group， with statistically significant difference （P <0.05）. Conclusion Intraspinal analgesia can not only relieve labor pain， but also accelerate the progress of labor and reduce the rate of conversion to cesarean section， which is worthy of popularization and application.

[Key words] Intraspinal analgesia; Cicatricial uterus; Vaginal delivery; Labor time; Delivery outcome; Analgesic effect

瘢痕子宫主要是因剖宫產术、子宫畸形矫形术等对女性子宫肌造成损伤后形成[1]。近年来，随着二孩政策的开放，使得瘢痕子宫再次妊娠孕妇的数量逐渐增多。但是，对于该类产妇来讲，若是再次妊娠时选择剖宫产进行分娩，尤其高龄产妇，则会对母婴的生命安全造成更大的威胁[2-3]。美国妇产科医师协会的相关指南表明，产妇再次妊娠引导试产中，采用硬膜外麻醉相对可靠，不会有较高不良反应发生率，不仅能够降低产妇因选择再次剖宫产所出现的风险，还能减少对产妇造成的伤害[4-5]。基于此，本研究主要将2019年1月至2020年12月，在我院进行阴道分娩的瘢痕子宫产妇作为研究的对象，采用椎管内镇痛分娩方式后，对其应用效果进行探析，现报道如下。

1资料与方法

1.1一般资料