张莉 彭敏

【摘要】 目的：探讨椎管内分娩镇痛对孕妇妊娠结局的影响。方法：选取2018年1-6月于笔者所在医院分娩的2 400例孕妇，随机分为观察组和对照组，每组1 200例。观察组给予椎管内分娩镇痛，对照组采取自然分娩（未行分娩镇痛）。结果：两组分娩方式及妊娠结局比较，差异均无统计学意义（P>0.05）。观察组第一产程、第二产程和总产程时长均长于对照组，差异均有统计学意义（P<0.05）。观察组与对照组新生儿Apgar评分、第三产程时长、产后出血率及产后2、24 h出血量比较，差异均无统计学意义（P>0.05）。观察组产时发热率、羊水污染及胎膜早破发生率均高于对照组，差异均有统计学意义（P<0.05）。结论：椎管内分娩镇痛可延长孕妇第一产程、第二产程和总产程时长，并可导致孕妇出现产时发热，但对新生儿窒息、产后出血率、产后出血量及第三产程时长无不良影响。

【关键词】 椎管内分娩镇痛 孕妇 妊娠结局 发热

doi：10.14033/j.cnki.cfmr.2019.30.016 文献标识码 B 文章编号 1674-6805（2019）30-00-03

[Abstract] Objective： To investigate the effect of intraspinal labor analgesia on the pregnancy outcome of pregnant women. Method： A total of 2 400 pregnant women who were delivered in our hospital from January to June 2018 were randomly divided into the observation group and the control group， with 1 200 cases in each group. The observation group was given intraspinal labor analgesia， and the control group was given natural delivery （no labor analgesia）. Result： The mode of delivery and pregnancy outcome were compared between the two groups， and the differences were not statistically significant （P>0.05）. The first stage of labor， the second stage of labor and the total stage of labor in the observation group were longer than those of the control group， and the differences were statistically significant （P<0.05）. The Apgar score， the third stage of labor， the postpartum hemorrhage rate and the amount of bleeding at 2 and 24 h postpartum were compared between the observation group and the control group， and the differences were not statistically significant （P>0.05）. The rates of fever during delivery， incidences of amniotic fluid contamination and premature rupture of membrane in the observation group were higher than those of the control group， and the differences were statistically significant （P<0.05）. Conclusion： Intraspinal labor analgesia can prolong the first stage of labor， the second stage of labor and the total stage of labor， and may lead to fever during delivery， but has no adverse effects on neonatal asphyxia， postpartum hemorrhage rate， postpartum bleeding volume， and third stage of labor.

[Key words] Intraspinal labor analgesia Pregnant women Pregnancy outcome Fever

First-authors address： Hubei Maternal and Child Health Hospital， Wuhan 430070， China

近年來随着医疗技术的进步，无痛分娩受到越来越多孕妇的关注[1]。椎管内分娩镇痛是安全、有效的镇痛方法，但在进行椎管内分娩镇痛时孕妇也会出现诸多不良症状，如发热、恶心、血压过低等[2-3]。由于对椎管内分娩镇痛的认知不足，阻滞了椎管内分娩镇痛在临床中的普及[4]。本研究旨在探讨椎管内分娩镇痛对孕妇妊娠结局的影响，报道如下。

1 资料与方法

1.1 一般资料

选取2018年1-6月于笔者所在医院分娩的2 400例孕妇。纳入标准：（1）初产、单胎足月;（2）年龄18～34岁;（3）头位，胎儿体重2.5～4.0 kg;（4）产前检查确认孕妇可经阴道分娩，无妊娠合并症及并发症。排除标准：（1）骨盆狭窄;（2）脊柱解剖异常;（3）对麻醉药物过敏;（4）胎儿情况不稳定等。将孕妇随机分为观察组和对照组，每组1 200例。观察组平均年龄为（28.03±3.01）岁;平均孕周为（39.42±0.86）周。对照组平均年龄为（27.59±3.25）岁;平均孕周为（38.93±1.02）周。两组平均年龄和孕周等一般资料对比，差异均无统计学意义（P>0.05）。