摘要
目的研究全产程分娩镇痛与第一产程分娩镇痛对瘢痕子宫再次妊娠阴道试产分娩四要素及免疫功能的影响。方法选取2018-06/2020-06月于作者医院待产并进行阴道试产的223例瘢痕子宫再次妊娠孕妇为研究对象,根据随机数字表法将产妇分为观察组(n=111)和对照组(n=112),其中观察组采用全产程分娩镇痛,对照组采用第一产程分娩镇痛。比较镇痛前、宫口开6 cm、宫口全开、胎头娩出时的视觉模拟评分(visual analogue scale,VAS),外周血T淋巴细胞(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平以及产力、产道、胎儿、精神心理状况,记录产后出血量、分娩持续时间,以及不良反应。结果观察组产后出血量显著低于对照组,而分娩时间、缩宫素使用率显著高于对照组(P<0.05)。两组产妇于宫口开6 cm、宫口全开、胎头娩出时的VAS显著低于镇痛前,观察组患者于宫口开6 cm、胎头娩出时的VAS显著低于对照组(P<0.05)。镇痛后两组患者各时间点的子宫工作量差异显著,其中宫口开6 cm、宫口全开时子宫工作量均高于镇痛前,第二产程完成时均低于镇痛前,且观察组产妇各时间点的子宫工作量均显著低于对照组(P<0.05)。两组产妇第二产程完成时的盆底肌肌力评分低于镇痛前,而宫颈评分高于镇痛前,其中观察组的盆底肌肌力评分、宫颈评分明显低于对照组(P<0.05)。两组产妇的平均长变异振幅、平均每小时胎心减速次数均明显增加,其中观察组第二产程完成时的各指标水平均明显低于对照组(P<0.05)。镇痛后两组产妇疼痛度显著降低,而产妇自控度、产妇满意度显著增加,且观察组第二产程完成时的各评分均优于对照组(P<0.05)。镇痛后CD4^(+)、CD4^(+)/CD8^(+)水平显著降低,而CD8^(+)水平均显著增加,其中观察组各水平显著优于对照组(P<0.05)。两组产妇不良反应发生率差异无统计学意义(P>0.05)。结论全产程分娩镇痛可
Objective To study the effect of total labor analgesia and first labor analgesia on the four factors and immune function of vaginal labor in the second pregnancy of scar uterus. Methods A total of 223 pregnant women with scar uterus in author′s hospital and underwent vaginal trial labor from June 2018 to June 2020 were selected as the research objects. The puerperas were divided into observation group with 111 cases and control group with 112 cases according to the random control table. The observation group was given labor analgesia during the whole stage of labor, while the control group was given the first stage labor analgesia. The visual analogue scale(VAS) scores were compared before analgesia, 6 cm after opening of uterine orifice, full opening of uterine orifice and delivery of fetal head, and the level of peripheral blood T lymphocyte(CD4^(+), CD8^(+), CD4^(+)/CD8^(+)) level and the labor force, birth canal, fetus and mental state were compared. The amount of postpartum hemorrhage, duration of delivery and adverse reactions were recorded. Results The amount of postpartum hemorrhage in the observation group was significantly lower than that in the control group, while the delivery time, oxytocin utilization rate was significantly higher than that in the control group(P<0.05).The VAS score of the two groups at 6 cm after opening of uterine orifice, full opening of uterine orifice and delivery of fetal head were significantly lower than those before analgesia. The VAS score of the patients in the observation group was significantly lower than that in the control group when the cervix opened 6 cm and the fetal head was delivered(P<0.05). There were significant differences in the uterine workload between the two groups after analgesia, in which the uterine workload when the cervix opened 6 cm and the uterine cervix dilated absolutely were higher than those before analgesia, the second stage of labor was lower than that before analgesia, and the uterine workload at all timing in the observation group was sig
作者
李楠楠
于树静
冯小明
彭希
李媛媛
LI Nannan;YU Shujing;FENG Xiaoming;PENG Xi;LI Yuanyuan(Department of Obstetrics,Maternal and Child Health Hospital of Tangshan,Tangshan Hebei 063000,China)
出处
《华南国防医学杂志》
CAS
2022年第8期609-614,共6页
Military Medical Journal of South China
基金
2020年度河北省医学科学研究课题(20201480)。
关键词
分娩镇痛
瘢痕子宫
第一产程
阴道分娩
分娩四要素
免疫功能
Labor analgesia
Scar uterus
First stage of labor
Vaginal delivery
Four labor elements
Immune function
