不同穿刺点椎管内麻醉分娩镇痛对产妇产程及母婴结局的影响

Effects of Intraspinal Anesthesia for Labor Analgesia at Different Puncture Points on Delivery Process and Maternal and Neonatal Outcomes

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摘要目的探讨不同穿刺点椎管内麻醉分娩镇痛对产妇产程及母婴结局的影响。方法选取2022年1月至2024年2月行椎管内麻醉分娩镇痛的120例阴道分娩产妇,采用随机数表法分为高位麻醉组(n=60)和低位麻醉组(n=60),2组产妇均采用程控硬膜外间歇脉冲注入+患者自控硬膜外镇痛,高位麻醉组行L 1~2穿刺椎管内麻醉,低位麻醉组行L 3~4穿刺椎管内麻醉。比较2组产妇失血量、产程总时长、麻醉指标、产妇分娩情况、新生儿结局以及不良反应发生情况。结果2组产妇失血量比较差异无统计学意义(P>0.05)。高位麻醉组产妇产程总时长较低位麻醉组短(P<0.05)。高位麻醉组产妇运动阻滞起效时间、感觉阻滞起效时间和感觉恢复时间均较低位麻醉组短,且麻醉阻滞神经节段数较低位麻醉组显著减少(P<0.05)。高位麻醉组产妇的第一产程和第二产程时间均较低位麻醉组短(P<0.05)。2组产妇的中转剖宫产率、阴道助产率和阴道分娩率比较差异无统计学意义(P>0.05)。高位麻醉组新生儿出生后1和5 min的Apgar评分均较低位麻醉组高(P<0.05)。高位麻醉组产妇不良反应总发生率为8.33%(5/60),低位麻醉组为10.00%(6/60),2组比较差异无统计学意义(P>0.05)。结论L 1~2穿刺椎管内麻醉在产妇分娩镇痛中具有较好效果,可以缩短产程,提高新生儿Apgar评分,且未显著增加不良反应。 Objective To investigate the effect of intraspinal anesthesia for labor analgesia at different puncture points on delivery process and maternal and neonatal outcomes.Methods A total of 120 parturients who underwent intraspinal anesthesia for labor analgesia and vaginal delivery from January 2022 to February 2024 were selected,and divided into high spinal anesthesia group(n=60)and low spinal anesthesia group(n=60)by random number table method.All parturients in both groups received program-controlled epidural intermittent pulse injection+patient-controlled epidural analgesia.The high spinal anesthesia group received L 1-2 intraspinal anesthesia,and the low spinal anesthesia group received L 3-4 intraspinal anesthesia.Maternal blood loss,total duration of labor,anesthesia indexes,maternal delivery,neonatal outcomes and adverse reactions were compared between the two groups.Results There was no significant difference in maternal blood loss between the two groups(P>0.05).The total duration of labor in high spinal anesthesia group was shorter than that in low spinal anesthesia group(P<0.05).The onset time of motor block,sensory block and sensory recovery time in high spinal anesthesia group were shorter than those in low spinal anesthesia group,and the number of anesthesia block ganglia was significantly reduced,as compared with low spinal anesthesia group(P<0.05).The first and second stages of labor in high spinal anesthesia group were shorter than those in low spinal anesthesia group(P<0.05).There was no significant difference in cesarean section rate,vaginal midwifery rate and vaginal delivery rate between the two groups(P>0.05).The Apgar score at 1 and 5 min after birth in the high spinal anesthesia group was higher than that in the low spinal anesthesia group(P<0.05).The total incidence of adverse reactions was 8.33%(5/60)in the high spinal anesthesia group and 10.00%(6/60)in the low spinal anesthesia group,and there was no significant difference between the two groups(P>0.05).Conclusion L 1-2 intraspinal anesthesia has a good effect on labor analgesia,which can shorten delivery process,improve neonatal Apgar score,and does not significantly increase adverse reactions.

作者叶海宾皇甫彪李莉白耀武 YE Haibin;HUANGFU Biao;LI Li;BAI Yaowu(Department of Anesthesiology,Tangshan Maternal and Child Health Hospital,Tangshan,Hebei 063000,China;Department of Obstetrics,Tangshan Maternal and Child Health Hospital,Tangshan,Hebei 063000,China)

机构地区唐山市妇幼保健院麻醉科唐山市妇幼保健院产科

出处《临床误诊误治》 2025年第1期70-74,共5页 Clinical Misdiagnosis & Mistherapy

基金 2024年度河北省医学科学研究课题计划(20241121)。

关键词椎管内麻醉分娩镇痛阻滞平面产妇产程母婴结局不良反应 Intraspinal anesthesia Labor analgesia Block plane Parturient Delivery process Maternal and neonatal outcome Adverse reaction

分类号 R714.3 [医药卫生—妇产科学]

作者简介叶海宾,本科,主治医师。主要从事麻醉方向研究。