椎管内分娩镇痛对子宫收缩持续时间和间隔时间的影响

目的 评价不同方式的椎管内分娩镇痛对子宫收缩持续时间和间隔时间的影响.方法 选择在首都医科大学附属北京妇产医院待产,要求分娩镇痛的初产妇60例,采用数字表法随机分为腰-硬联合阻滞组（C组）和硬膜外阻滞组（E组）,观察2组产妇镇痛前后的视觉模拟评分法（VAS）评分、缩宫素使用率及子宫收缩持续时间和间隔时间,评价2种方式椎管内分娩镇痛对子宫收缩的影响.结果 1）2组产妇镇痛后VAS评分均较镇痛前明显降低（P〈0.05）,且C组的镇痛起效时间明显短于E组（P〈0.01）.2）2组产妇镇痛后缩宫素使用率均较镇痛前明显增高（P〈0.05）,但两组间差异无统计学意义（P〉0.05）.3）2组产妇在镇痛后均有一过性的子宫收缩持续时间缩短和间隔时间延长.C组在镇痛后5～30 min出现宫缩持续时间较镇痛前缩短,且镇痛后15～30 min出现宫缩间隔时间延长（P〈0.05）.E组在镇痛后10～30 min出现宫缩持续时间缩短（P〈0.05）,但镇痛前后宫缩间隔时间差异无统计学意义（P〉0.05）.结论 腰-硬联合阻滞和硬膜外阻滞用于分娩镇痛效果确切,但对子宫收缩有一过性影响,即在镇痛后30 min内可引起一过性的子宫收缩持续时间缩短及间隔时间延长.正确认识分娩镇痛对宫缩影响并进行处理,有利于分娩镇痛的顺利实施.

Impact of intrathecal labor analgesia on duration and interval of uterine contraction

Objective To investigate the impact of intrathecal labor analgesia on duration and interval of uterine contraction. Methods In this prospective study, 60 parturients from Beijing Obstetrics and Gynecology Hospital who would like to have labor analgesia were randomized into two groups, one into spinal-epidural anesthesia group （group C） and the other into epidural anesthesia group （group E）. The visual analogue scores （VAS） of pre-and post analgesia, rates of oxytocin use, the duration and interval time of uterus contraction were observed and recorded. Results 1 ） Compared to no analgesia, VAS scores were significantly reduced after analgesia in both groups. In this study,it was found that the onset of analgesia in the group C was significantly shorter than the group E （ P 〈 0.01 ）. 2） The oxytocin usage increased after analgesia in each group （P 〈 0.05 ）. Oxytocin usage was similar after analgesia （P 〉 0. 05 ） in both groups. 3 ） After labor analgesia, duration of uterine contraction was shortened and interval of uterine contraction was extended within a short time. Duration of uterine contraction was shortened in the group C 5 - 30 rain after analgesia （P 〈 0.05 ） , duration of uterine contraction was shortened in the group E 10 - 30 min after analgesia （P 〈 0.05）. Interval of uterine contraction was extended in group C 15 - 30 rain after analgesia （P 〈 0.05 ）. There was no significant difference after labor analgesia in group E in the interval of uterine contraction （ P 〉 0. 05）. Conclusion Combined spinal-epidural anesthesia and epidural anesthesia in labor analgesia can provide a good analgesic effect, but labor analgesia have a certain influence on uterine contraction. Duration of uterine contraction was shortened and interval of uterine contraction was extended within a short time, understanding of uterine contraction characteristics, and effective treatment contribute to the success of labor analgesia.