腰硬联合麻醉分娩镇痛转剖宫产的指征分析

发布时间：2018-11-09 13:42

【摘要】：【目的】探讨腰硬联合麻醉(CSE)分娩镇痛产程中转剖宫产的指征及影响因素。【方法】选择2009年1月至2013年12月有阴道试产条件行腰硬联合麻醉分娩镇痛转剖宫产的428例产妇为研究组,同期未行分娩镇痛阴道试产转剖宫产的430例产妇为对照组,分析比较两组的剖宫产指征及影响因素。【结果】两组的剖宫产指征依次为:头位难产、胎儿窘迫、社会因素,瘢痕子宫,研究组的头位难产率高于对照组(P0.01),而胎儿窘迫、社会因素为指征的剖宫产率低于对照组(P0.05、P0.01);两组头位难产的前3位影响因素是:持续性枕后位、持续性枕横位,头盆不称(枕前位);研究组胎儿窘迫的前3位影响因素是脐带因素、绒毛膜羊膜炎,妊娠合并症,对照组胎儿窘迫的前3位影响因素是脐带因素、不明原因的羊水混浊,绒毛膜羊膜炎;研究组的新生儿窒息率低于对照组(P0.05),缩宫素使用率高于对照组(P0.01)。【结论】腰硬联合麻醉分娩镇痛可以降低胎儿窘迫及新生儿窒息的发生率,但头位难产的风险增高,加强产程的观察、处理以及镇痛方法的改进可能是降低剖宫产率的有效方法。
[Abstract]:[objective] to investigate the indications and influencing factors of (CSE) combined spinal-epidural anesthesia during labor analgesia and labor analgesia to cesarean section. [methods] to select the vaginal trial labor condition from January 2009 to December 2013 to perform analgesia conversion from labor under combined spinal-epidural anesthesia to cesarean section. The study group consisted of 428 pregnant women. In the same period, 430 pregnant women who did not undergo labor analgesia, vaginal trial labor and cesarean section were used as control group. The indications of cesarean section and the influencing factors were analyzed and compared between the two groups. [results] the indications of cesarean section in the two groups were in turn: head position dystocia, fetal distress and social factors. The rate of cephalic dystocia in the study group was higher than that in the control group (P0.01), and the rate of cesarean section indicated by social factors was lower than that in the control group (P0.05, P0.01). The first three influencing factors of dystocia in cephalic position were: persistent occipital posterior position, persistent occipital transverse position, cephalopelvic disproportion (occipital anterior position); The first three influencing factors of fetal distress in study group were umbilical cord factor, chorioamnionitis, pregnancy complication, and in control group, umbilical cord factor, unexplained amniotic fluid opacity, chorioamnionitis; The neonatal asphyxia rate in the study group was lower than that in the control group (P0.05), and the rate of oxytocin utilization was higher than that in the control group (P0.01). [conclusion] the incidence of fetal distress and neonatal asphyxia can be reduced by combined spinal-epidural analgesia. However, the risk of dystocia in cephalic position is increased. Strengthening the observation, treatment and improvement of analgesia may be an effective method to reduce the rate of cesarean section.
【作者单位】：中山大学附属第三医院妇产科;
【基金】：广东省科技计划项目(2011B031700024)
【分类号】：R614

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