摘要
目的:探讨硬膜外患者自控分娩镇痛(Patient cotrolled epidural analgesia,PCEA)与经皮神经电刺激(Transcutaneous electrical nerve stimulation,TENS)镇痛对不同体质量指数(Body mass index,BMI)足月初产妇分娩结局的影响.方法:选取2019年1月至2021年1月于赣南医科大学第一附属医院产科住院行阴道试产的足月初产妇为研究对象,根据纳排标准纳入产妇共401例,将入院时BMI≥30 kg·m-2的产妇设为肥胖产妇,BMI＜30 kg·m-2的产妇设为非肥胖产妇.实施PCEA的产妇为PCEA组(136例)、行TENS镇痛的产妇为TENS组(142例)、无镇痛干预的产妇为对照组(123例).分别比较:⑴3组产妇第一、第二、第三产程时间;⑵3组产妇分娩镇痛前(T0)、镇痛后0.5 h(T1)、镇痛后1 h(T2)、宫口开全时(T3)的疼痛评分;⑶3组产妇分娩结局.结果:在肥胖产妇中:各产程时间比较,第一产程、第二产程时间PCEA组＞对照组＞TENS组,差异均有统计学意义(P＜0.05),第三产程时间3组比较差异无统计学意义(P＞0.05);3组产妇各时间点VAS疼痛评分比较差异均有统计学意义(F组间=553.952,P组间＜0.001;F时间=198.576,P时间＜0.001;F交互=15.653,P交互＜0.001);3组产妇缩宫素使用率、会阴切开率、中转剖宫产率组间比较差异有统计学意义(P＜0.05),且PCEA组会阴切开率高于TENS组(P＜0.017);3组间产钳助产率、人工破膜率、软产道裂伤率、1分钟新生儿窒息率比较差异均无统计学意义(P＞0.05).在非肥胖产妇中:各产程时间比较,第一产程时间对照组＞TENS组＞PCEA组,第二产程时间PCEA组＞对照组＞TENS组,差异均有统计学意义(P＜0.05),第三产程时间3组比较差异无统计学意义(P＞0.05);3组产妇各时间点VAS疼痛评分比较差异均有统计学意义(F组间=3 417.991,P组间＜0.001;F时间=1 330.580,P时间＜0.001;F交互=94.479,P交互＜0.001);3组缩宫素使用率差异有统计学意义(P＜0.05),且PCEA组缩宫素使用率高于TENS组(P＜0.017);3组产钳助产率、人工破膜率、会阴切开率、软产道裂伤率、中转剖宫产率、1分钟新生儿窒息率、5分钟新生儿窒息率比较差异均无统计学意义(P＞0.05).结论:自控硬膜外分娩镇痛及经皮神经电刺激镇痛对不同BMI产妇镇痛效果显著,无短期母婴不良影响,但可能会影响产妇第一产程、第二产程时间.
Abstract
Objective:To investigate the impact of patient controlled epidural analgesia(PCEA)and transcutaneous electrical nerve stimulation(TENS)on the delivery outcomes of full-term primiparous women with different BMIs.Methods:A total of 401 primiparous women who delivered vaginally at The First Affiliated Hospital of Gannan Medical University from January 2019 to January 2021 were selected as the research subjects according to inclusion and exclusion criteria.They were divided into three groups based on their body mass index(BMI):obese women with BMI≥30 kg·m-2,non-obese women with BMI＜30 kg·m-2.Those who received PCEA(PCEA group,n=136),received TENS(TENS group,n=142),and received no analgesia(control group,n=123).The following elements were compared among the three groups:⑴the duration of the first,second,and third stages of labor;⑵ the pain scores of the three groups before analgesia,0.5 h after,1 h after,and at the time of delivery(T3);⑶ the delivery outcomes of the three groups.Results:In obese women:the comparison of the duration of each stage of labor showed that the first and second stages of labor in the PCEA group were longer than those in the control group and TENS group,respectively,with statistically significant differences(P＜0.05).There was no statistically significant difference in the third stage of labor among the three groups(P＞0.05).The VAS pain scores of the three groups of women at different time points were with statistical significance(Fgroup=553.952,Pgroup＜0.001;Ftime=198.576,Ptime＜0.001;Finteraction=15.653,Pinteraction＜0.001).The use rate of oxytocin,episiotomy rate,and cesarean section rate among the three groups were statistical significant(P＜0.05),and the episiotomy rate of the PCEA group was higher than that of the TENS group(P＜0.017).The rates of vacuum extraction assisted delivery,artificial rupture of membranes,soft tissue injury,and 1-minute neonatal asphyxia were not statistical significant among the three groups(P＞0.05).In non-obese women:the comparison of the duration of each stage of labor showed that the first stage of labor was longer in the control group than those in the TENS group and PCEA group,with statistical significance(P＜0.05).The second stage of labor was longer in the PCEA group than those in the control group and TENS group,with statistical significance(P＜0.05).There was no statistical significance in the third stage of labor among the three groups(P＞0.05).The VAS pain scores of the three groups at different time points were statistically significant(Fgroup=3 417.991,Pgroup＜0.001;Ftime=1 330.580,Ptime＜0.001;Finteraction=94.479,Pinteraction＜0.001).The use rate of oxytocin was statistically significant among the three groups(P＜0.05),and it was higher in PCEA than that of the TENS(P＜0.017);the rates of vacuum extraction assisted delivery,artificial rupture of membranes,the episiotomy rate,soft tissue injury,cesarean section rate,1-minute neonatal asphyxia and 5-minute neonatal asphyxia were with no statistical significance(P＞0.05).Conclusion:Self-controlled epidural labor analgesia and percutaneous nerve stimulation analgesia have significant analgesia effects on women with different BMI,and have no short-term adverse effects on mothers and children,but may affect the time of the first and second stages of labor.
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