摘要
目的探讨椎管内镇痛对臀位妊娠产妇行外倒转术(external cephalic version,ECV)成功率及不良反应的影响。方法90例单胎、臀位妊娠的产妇,按随机数字表法分为3组(每组30例):对照组(C组),行ECV时不做镇痛;硬膜外镇痛组(EA组),行ECV时采用硬膜外阻滞进行镇痛;腰硬联合镇痛组(CSEA组),行ECV时采用腰硬联合阻滞进行镇痛。记录3组产妇行ECV时的VAS疼痛评分,对疼痛缓解的满意度评分,ECV成功率(瞬时成功率和总成功率),转剖宫产率,产妇和胎儿不良反应的发生情况。结果EA组、CSEA组产妇行ECV时的VAS疼痛评分低于C组(P<0.05),对疼痛缓解的满意度评分高于C组(P<0.05);EA组与CSEA组行ECV时的VAS疼痛评分及对疼痛缓解的满意度评分差异无统计学意义(P>0.05)。EA组和CSEA组行ECV的瞬时成功率、总成功率高于对照组(P<0.05),转剖宫产率低于C组(P<0.05);EA组、CSEA组行ECV的瞬时成功率、总成功率及转剖宫产率差异无统计学意义(P>0.05)。CSEA组低血压的发生率高于对照组(P<0.05),3组产妇胎心率减慢、恶心呕吐、胎盘早剥的发生率差异无统计学意义(P>0.05)。结论单胎、臀位妊娠的孕妇行ECV时,硬膜外镇痛或腰硬联合镇痛更能有效矫正胎位,降低剖宫产率;但腰硬联合镇痛下产妇低血压的发生率较高。
Objective To investigate the effect of intrathecal analgesia on the success rate and adverse reactions of external cephalic version(ECV)in women with breech pregnancy.Methods A total of 90 women with singleton breech pregnancy were selected.According to the random number table method,they were divided into three groups(n=30):a control group(group C)which did not receive analgesia during ECV,an epidural analgesia group(group EA)which underwent epidural block for analgesia during ECV,and a combined spinal-epidural analgesia(CSEA)group which received combined spinal-epidural block for analgesia during ECV.Their Visual Analogue Scale(VAS)scores during ECV,satisfaction score for pain relief,ECV success rate(instantaneous success rate and overall success rate),transfer cesarean section rate,maternal and fetal adverse reactions were recorded.Results Compared with group C,group EA and group CSEA showed decreased VAS scores during ECV(P<0.05),and increased satisfaction scores for pain relief(P<0.05).There was no statistical difference in VAS score and satisfaction score between group EA and group CSEA during ECT(P>0.05).The instantaneous success rate and overall success rate of ECV in group EA and group CSEA were higher than those in the group C(P<0.05),while the rate of transfer to cesarean section was lower than that in group C(P<0.05).There were no statistical differences in instantaneous success rate,overall success rate and transfer caesarean section rate between group EA and group CSEA(P>0.05).Group CSEA presented a higher incidence of hypotension than group C(P<0.05).There were no statistical differences in the incidence of fetal heart rate slowing,nausea and vomiting,and placental abruption among the three groups(P>0.05).Conclusions When ECV is performed in women with singleton breech pregnancy,epidural analgesia or combined spinal-epidural analgesia are more effective in correcting fetal position and reducing the rate of caesarean section.However,the incidence of hypotension is remarkably higher with spinal-epidu
作者
张静静
张绪东
嵇富海
Zhang Jingjing;Zhang Xudong;Ji Fuhai(Department of Anesthesiology,Weifang Maternal and Child Health Hospital,Weifang 261000,China;Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)
出处
《国际麻醉学与复苏杂志》
CAS
2023年第2期174-178,共5页
International Journal of Anesthesiology and Resuscitation
关键词
硬膜外镇痛
腰硬联合镇痛
妊娠
外倒转术
Epidural analgesia
Spinal-epidural analgesia
Pregnancy
External cephalic version
