摘要
目的探讨椎管内镇痛下经阴试产中转剖宫产的危险因素。方法回顾分析2020年8月—2021年2月在青岛市妇女儿童医院行椎管内分娩镇痛的989例产妇的临床资料,将阴道试产失败后转剖宫产的92例产妇作为剖宫产组,随机抽取同期在椎管内镇痛下经阴顺产的276例产妇作为顺产组。比较两组产妇各项临床观察指标的差异。结果与顺产组比较,剖宫产组临产BMI、临产孕周、产次、胎儿体质量及镇痛时宫口大小、镇痛期间发热、追加药物次数差异有统计学意义(χ^(2)=37.80,t=-4.60~37.80,P<0.05);两组产妇的年龄、妊娠合并症、镇痛方式比较差异无统计学意义(P>0.05)。Logistic回归分析显示,镇痛期间发热(OR=4.815,95%CI=2.394~9.686,P<0.05)、胎儿体质量(OR=1.001,95%CI=1.001~1.002,P<0.05)、追加药物次数(OR=2.233,95%CI=1.134~4.400,P<0.05)、产次(OR=0.284,95%CI=0.150~0.537,P<0.05)以及镇痛时宫口大小(OR=0.740,95%CI=0.554~0.989,P<0.05)是椎管内分娩镇痛经阴试产转剖宫产的相关因素。结论镇痛期间发热、胎儿体质量、追加药物次数是椎管内分娩镇痛经阴试产转剖宫产的危险因素,产次、镇痛时宫口大小是保护性因素。
Objective To explore risk factors for intrapartum conversion to a cesarean section from a vaginal delivery attempt with intraspinal analgesia.Methods We reviewed the clinical data of 989 parturient women who underwent intraspinal analgesia for labor in the Qingdao Women and Children’s Hospital from August 2020 to February 2021.We included 92 parturient women(experiencing conversion to a cesarean section after a failed attempt to deliver vaginally)into cesarean section group,and 276 parturient women(having a successful vaginal delivery under intraspinal analgesia during the same period)into vaginal delivery group.Clinical indicators were compared between the two groups.Results Significant differences were observed in body mass index,gestational weeks near labor,parity,fetal weight,cervical size at analgesia,fever during analgesia,and the times of additional drug administration between the cesarean section and vaginal delivery groups(χ^(2)=37.80,t=-4.60-37.80,P<0.05).The two groups had no significant differences in age,pregnancy complications,and analgesic methods(P>0.05).The logistic regression analysis showed that fever during analgesia(OR=4.815,95%CI=2.394-9.686,P<0.05),fetal weight(OR=1.001,95%CI=1.001-1.002,P<0.05),the times of additional drug administration(OR=2.233,95%CI=1.134-4.400,P<0.05),parity(OR=0.284,95%CI=0.150-0.537,P<0.05),and cervical size at analgesia(OR=0.740,95%CI=0.554-0.989,P<0.05)were the factors affecting conversion from a vaginal delivery attempt under intraspinal analgesia to a cesarean section.Conclusion Fever during analgesia,fetal weight,and the times of additional drug administration are risk factors for conversion to a cesarean section from a vaginal delivery attempt with intraspinal analgesia,while parity and cervical size at analgesia are its protective factors.
作者
姜英霞
王晗
刘少艳
逄淑萍
陈作雷
JIANG Yingxia;WANG Han;LIU Shaoyan;PANG Shuping;CHEN Zuolei(Department of Anesthesiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《精准医学杂志》
2022年第3期213-216,221,共5页
Journal of Precision Medicine
基金
山东省医药卫生科技发展计划项目(2020041112-73)。
关键词
镇痛
产科
镇痛
硬膜外
分娩
剖宫产术
危险因素
Analgesia,obstetrical
Analgesia,epidural
Parturition
Cesarean section
Risk factors
