上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

椎管内镇痛对孕妇臀位外倒转术的辅助疗效

李海冰1，方昕1，赵青松1，沈富毅1，林蓉1，刘志强1,朱丽萍2   

  1. 1．同济大学附属第一妇婴保健院麻醉科, 上海 200040； 2.上海市妇幼保健中心， 上海 200010
  • 出版日期:2016-01-28 发布日期:2016-02-26
  • 通讯作者: 刘志强, 电子信箱: drliuzhq@hotmail.com。
  • 作者简介:李海冰（1972—）， 男， 副主任医师， 博士; 电子信箱: hiblee@163.com。
  • 基金资助:

    上海市科委医学引导项目 (14411966700)

Assistant therapeutic effect of external cephalic version under intrathecal anesthesia for breech position pregnant women

LI Hai-bing1, FANG Xin1, ZHAO Qin-song1, SHEN Fu-yi1, LIN Rong1, LIU Zhi-qiang1, ZHU Li-ping2   

  1. 1.Department of Anesthesiology， First Maternity and Infant Hospital affiliated to Tongji University, Shanghai 200040， China； 2.Shanghai Maternal and Child Health Center， Shanghai 200010, China
  • Online:2016-01-28 Published:2016-02-26
  • Supported by:

    Foundation of Shanghai Municipality Science and Technology Commission, 14411966700。

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摘要：

目的 探讨椎管内镇痛下对臀位单胎妊娠孕妇实施外倒转术的成功率，并分析外倒转术的并发症发生情况。方法 将60例定期产前检查并分娩的孕妇随机分为硬膜外麻醉组（EA组）和腰硬联合阻滞麻醉组（CSEA组），每组30例；另设无任何镇痛的30例孕妇为对照组。采用视觉模拟评分法比较3组行外倒转术时孕妇疼痛评分；比较3组转为头位的比例、剖宫产率、不良反应的发生率。结果 实施椎管内镇痛后，EA组和CSEA组孕妇疼痛评分分别为1.87±2.94和1.73±2.71,明显优于对照组的6.84±3.08（P=0.031和P=0.027）。EA组瞬时外倒转成头位的比例为78.3%，高于CSEA组的51.7%和对照组的48.3%（P=0.023和P=0.041）；CSEA组与对照组比较，差异无统计学意义。与CSEA组和对照组比较，EA组剖宫产率、臂位为第一指征剖宫产率均较低，差异均有统计学意义（P=0.037和P=0.029）。CSEA组孕妇低血压、恶心呕吐、胎心率减慢的发生率均明显高于对照组，差异均有统计学意义（P=0.021, P=0.042, P=0.033）。3组孕妇在外倒转术期间均无胎盘早剥发生。3组孕妇在外倒转术后早产和脐带绕颈的发生率比较，差异均无统计学意义。结论 对于臀位单胎妊娠孕妇，经硬膜外镇痛后实施的外倒转术可有效矫正胎位，降低剖宫产率；经腰硬联合镇痛是否能提高瞬时外倒转术的成功率尚不明确。

关键词: 硬膜外麻醉, 腰硬联合阻滞麻醉, 臀先露, 外倒转术

Abstract:

Objective To investigate the success rate of external cephalic version under intrathecal analgesia for breech position singleton pregnant women and analyze the complications of external cephalic version. Methods A total of 60 pregnant women who have undergone regular prenatal examinations and delivered normally were randomly divided into epidural anesthesia group (EA group, n=30) and combined spinal-epidural anesthesia group (CSEA group, n=30). Another 30 pregnant women who have delivered without analgesia were selected as controls. The pain scores of pregnant women of three groups when conducting the external cephalic version were compared by visual analogue scales. The proportion of head position, rate of cesarean section, and rate of adverse reactions of three groups were compared. Results After intrathecal analgesia was performed, the pain scores of EA group and CSEA group were 1.87±2.94 and 1.73±2.71, respectively, which were significantly lower than that of control group (6.84±3.08)(P=0.031 and P=0.027). The success rate of external cephalic version of EA group was 78.3%, which was higher than that of CSEA group (51.7%) and control group (48.3%)(P=0.023 and P=0.041). The difference between CSEA group and control group was not statistically significant. Compared with CSEA group and control group, both the rate of cesarean section and the rate of cesarean section with breech position as the first indication of EA group were lower and the differences were statistically significant (P=0.037 and P=0.029). The incidences of hypotension, nausea and vomiting, and decreased fetal heart rate of CSEA group were remarkably higher than those of control group and the differences were statistically significant (P=0.021, P=0.042, P=0.033). The placental abruption did not occur during the external cephalic version among pregnant women of three groups. The differences of incidences of preterm birth and umbilical cord around neck of three groups after external cephalic version were not statistically significant. Conclusion For breech position singleton pregnant women, the external cephalic version after epidural analgesia can effectively correct the fetal position and decrease the rate of cesarean section. But whether combined spinal-epidural analgesia can improve the success rate of instantaneous external cephalic version remains unclear.

Key words: epidural anesthesia, combined spinal-epidural anesthesia, breech presentation, external cephalic version