黄瑞平 劳诚毅 刘珍玉

[摘要] 目的 探讨全产程腰硬联合阻滞分娩镇痛联合气囊仿生助产在瘢痕子宫妊娠阴道试产中应用的可行性及安全性。方法 随机选取该院2018年9月—2019年9月收治的150名符合阴道试产的瘢痕子宫妊娠孕妇，随机平均分成3组，A组采用腰硬联合阻滞分娩镇痛加气囊仿生助产;B组采用腰硬联合阻滞分娩镇痛;C组采用气囊仿生助产。结果 A组总产程为（483.2±97.9）min，B组为（684.5±102.7）min，C组为（692.6±101.2）min，A组的总产程明显小于B组与C组（t=24.080、24.560，P=0.000、0.000）;A組的产后出血量为（343.2±42.8）mL，B组为（386.1±52.3）mL，C组为（385.4±54.7）mL，A组的产后出血量小于B组与C组，（t=35.900、34.940，P=0.000、0.000）;A组宫口开1 cm、5 cm和全开时的VAS评分分别为（2.2±0.7）分、（3.9±0.6）分、（4.2±0.6）分，B组分别为（2.5±0.6）分、（3.8±0.7）分、（4.5±0.7）分，C组分别为（8.7±0.7）分、（7.9±0.5）分、（9.2±0.3）分，宫口开1 cm时（t=1.940、47.550，P=0.050、0.000），宫口开5 cm（t=0.760、33.700，P=0.440、0.000），全开时（t=1.870、43.630，P=0.050、0.000），3组宫口开1 cm、5 cm和全开时疼痛评分比较，A组与B组对比差异无统计学意义（P>0.05），A组和B组均低于C组，差异有统计学意义（P<0.05）。 结论 在瘢痕子宫妊娠阴道试产中选用全称腰硬联合阻滞分娩镇痛联合气囊仿生助产方式相较于另外两种方式，总产程短，产后出血量少，整个产程疼痛评分低。

[关键词]  腰硬联合阻滞;瘢痕子宫;阴道试产;气囊仿生助产

[Abstract] Objective To explore the feasibility and safety of full-course lumbar epidural combined with block analgesia combined with balloon biomimetic midwifery in the trial of vaginal pregnancy in scar uterine pregnancy. Methods From September 2018 to September 2019， random selection 150 cases of pregnant admission women with uterine scars who were eligible for vaginal trials were randomly divided into three groups at random. Group A used lumbar-scleral combined block analgesia plus balloon biomimetic midwifery; Group B used combined spinal and epidural analgesia for delivery and analgesia; Group C used bladder to assist labor. Results The total delivery time of group A was （483.2±97.9）min， that of group B was （684.5±102.7）min， and that of group C was （692.6±101.2）min. The total delivery time of group A was significantly smaller than that of groups B and C（t=24.080， 24.560， P=0.000， 0.000）; postpartum hemorrhage in group A was （343.2±42.8） mL， （386.1±52.3）mL in group B（385.4±54.7） mL in group C， and postpartum hemorrhage in group A was less than Groups B and C （t=35.900， 34.940， P=0.000， 0.000）; VAS scores of group A with 1 cm， 5 cm and full opening were （2.2±0.7） points， （3.9±0.6） ） points， （4.2±0.6） points， group B were （2.5±0.6） points， （3.8±0.7） points， （4.5±0.7） points， and group C were （8.7±0.7） points， （7.9±0.5） points. （9.2±0.3）points， when the mouth is opened 1 cm （t=1.940， 47.550， P=0.050， 0.0000）， the mouth is opened 5 cm （t=0.760， 33.700， P=0.440， 0.000）， when fully opened （t=1.870， 43.630， P=0.050， 0.000）， the three groups of uterine opening 1 cm， 5 cm and pain scores when compared， there was no statistically significant difference between group A and group B（P>0.05）， group A and group B were lower than group C， the difference was statistically significant （P<0.05）.Conclusion Compared with the other two methods， the full-length lumbar epidural combined with analgesia and childbirth combined with balloon biomimetic midwifery is used in the trial of vaginal pregnancy in scar uterine pregnancy.

[Key words] Combined spinal and rigid block; Scar uterus; Vaginal trial; Balloon bionic midwifery

近些年，随着生活水平的不断提高，人们对生殖健康的要求也相应提高。瘢痕子宫再次妊娠的分娩方式已是临床人生中面临的较大难题，剖宫产可以良好的分娩，但其会显著地加重对子宫的损伤，易引发感染、切口愈合不良等，在术后易产生盆腔黏连、瘢痕部位妊娠等并发症，对母体健康损伤相对较大。陰道顺产相对对母婴健康损伤较小，但其对产妇自身的要求较高，既要有良好的妊娠状况，也要求母体各方面的健康状况良好，因此能够适应的产妇数量较少，为此临床不断加强对妊娠分娩的研究，更好地保障母婴……