余冬梅+骆晓芳+赵丽君+罗小琴+罗思

【摘要】 目的 分析和研究无痛分娩对母胎的影响。方法 85例分娩初产妇， 按有无分娩镇痛分为无痛分娩组（45例）与对照组（40例）。其中所选产妇均为自然临产， 对比两组产妇第一及第二产程所用时间、宫缩乏力、产后出血量、新生儿窒息、剖宫产、产后尿潴留发生情况。结果 无痛分娩组第一产程时间为（517.08±56.69）min， 剖宫产发生率为13.33%；對照组第一产程时间为（580.500±84.257）min，

剖宫产发生率为32.50%， 无痛分娩组第一产程及剖宫产发生率均明显优于对照组（P<0.05） 。无痛分娩组宫缩乏力为20.0%、产后尿潴留发生率为15.6%， 均高于对照组的2.5%、2.5%， 差异具有统计学意义（P<0.05）。两组第二产程时间、产后2 h出血量及新生儿窒息发生率对比差异无统计学意义（ P>0.05）。结论 无痛分娩可加速第一产程、降低剖宫产率， 而产时宫缩乏力发生率明显升高， 催产素的使用增加， 产后尿潴留的发生率增加。

【关键词】 无痛分娩；产程；宫缩乏力；尿潴留

DOI：10.14163/j.cnki.11-5547/r.2017.01.019

Clinical analysis of influence by painless labor on mother and fetus YU Dong-mei， LUO Xiao-fang， ZHAO Li-jun， et al. Department of Obstetrics and Gynecology， Guangdong Dongguan City Hengli Hospital， Dongguan 523460， China

【Abstract】 Objective To analyze and research influence by painless labor on mother and fetus. Methods A total of 85 primipara were divided by their labor analgesia into painless labor group （45 cases） and control group （40 cases）. All primipara had spontaneous labor. Comparison was made on first and second stages of labor time， uterine inertia， postpartum bleeding volume， neonatal asphyxia， cesarean section and postpartum uroschesis status between the two groups. Results The painless labor group had first stage of labor as （517.08±56.69） min and incidence of cesarean section as 13.33%. The control group had first stage of labor as （580.500±84.257） min and incidence of cesarean section as 32.50%. The painless labor group had obviously better first stage of labor and incidence of cesarean section than the control group （P<0.05）. The painless labor group had incidence of uterine inertia as 20.0% and incidence of postpartum uroschesis as 15.6%， which were all higher than 2.5% and 2.5% in the control group， and their difference had statistical significance （P<0.05）. There was no statistically significant difference of second stage of labor， incidences of 2 h postpartum bleeding volume and neonatal asphyxia between the two groups （P>0.05）. Conclusion Painless labor can accelerate first stage of labor and reduce incidence of cesarean section， however it leads to remarkably increased incidence of intrapartum uterine inertia， dose of oxytocin and incidence of postpartum uroschesis.

【Key words】 Painless labor； Stage of labor； Uterine inertia； Uroschesis

初产妇未经过的疼痛体会， 来自亲人、朋友分娩的不良信息的传导， 导致产妇惧怕分娩疼痛， 缺乏阴道分娩的信心， 因社会因素导致的无指征的剖宫产率上升， 极易给产妇的心理及生理带来严重的创伤[1]。腰硬联合麻醉是目前国内外常用的麻醉方法之一， 具有用药量少、起效迅速、镇痛完全， 且不对产妇交感神经和运动神经产生抑制作用等优点， 产妇分娩时可正确屏气用力， 肢体可自由活动， 并可通过进食补充体力[2]。通过分娩镇痛即产时持续性椎管内麻醉可明显减轻产妇分娩时的痛苦， 使顺产的几率增加。……