椎管内分娩镇痛对母婴结局的影响

doi:10.12280/gjfckx.20240594

摘要/Abstract

摘要：

椎管内分娩镇痛是缓解产妇分娩疼痛的主要方法，在第一产程潜伏期实施椎管内分娩镇痛能够大大减轻产妇的分娩疼痛，使得产妇更加愿意尝试阴道分娩，降低了剖宫产率，尤其是疼痛因素导致的无明确医学指征的剖宫产，可降低严重孕产妇合并症（severe maternal morbidity，SMM）和产后出血的发生率，提高了分娩质量。然而，椎管内分娩镇痛可能会对母婴结局产生一些不利影响。在第一产程潜伏期实施椎管内分娩镇痛可加速宫颈的扩张，但第一产程活跃期、第二产程时间更长。椎管内镇痛会增加产妇阴道助产和产后尿潴留的风险，产后尿潴留可导致泌尿系统的感染和产后出血。此外，产时发热可能与椎管内分娩镇痛有关。胎膜早破、阴道检查次数过多、分娩时间过长、胎膜破裂到分娩结束的时间过长、产妇体质量指数高、椎管内分娩镇痛持续时间长是产时发热的危险因素，产时发热可能会增加新生儿低Apgar评分与新生儿感染的风险，导致新生儿不良结局。综述椎管内分娩镇痛对产程、分娩方式及母婴结局的影响，为提高分娩质量，减少母婴不良结局提供参考。

关键词: 椎管, 镇痛, 产科, 分娩, 产道, 发热, 妊娠结局

Abstract:

Intraspinal labor analgesia is a primary method for alleviating labor pain in women. Administering intraspinal labor analgesia during the latent phase of the first stage of labor can significantly reduce labor pain, making women more willing to attempt vaginal delivery and thereby reducing the rate of cesarean sections, especially those without clear medical indications due to pain factors. It can also decrease the incidence of severe maternal morbidity (SMM) and postpartum hemorrhage, thus improving the quality of delivery. However, intraspinal labor analgesia may have some adverse effects on maternal and neonatal outcomes. While it can accelerate cervical dilation during the latent phase of the first stage of labor, it may prolong the active phase of the first stage and the second stage of labor. Intraspinal analgesia increases the risk of instrumental vaginal delivery and postpartum urinary retention, with the latter potentially leading to urinary tract infections and postpartum hemorrhage. Additionally, intrapartum fever may be associated with intraspinal labor analgesia. Risk factors for intrapartum fever include premature rupture of membranes, excessive vaginal examinations, prolonged labor duration, prolonged time from rupture of membranes to delivery, high maternal body mass index, and prolonged duration of intraspinal labor analgesia. Intrapartum fever may increase the risk of low Apgar scores and neonatal infections, leading to adverse neonatal outcomes. This review examines the impact of intraspinal labor analgesia on labor progress, delivery mode, and maternal and neonatal outcomes, providing a reference for improving delivery quality and reducing adverse maternal and neonatal outcomes.

Key words: Spinal canal, Analgesia, obstetrical, Labor, obstetric, Fever, Pregnancy outcome

唐仕诚, 张国英. 椎管内分娩镇痛对母婴结局的影响[J]. 国际妇产科学杂志, 2024, 51(5): 519-524.

TANG Shi-cheng, ZHANG Guo-ying. Effects of Intraspinal Labor Analgesia on Maternal and Neonatal Outcomes[J]. Journal of International Obstetrics and Gynecology, 2024, 51(5): 519-524.

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