硬膜外分娩镇痛泵关闭时机对子痫前期产妇分娩结局的影响

Effect of epidural analgesia pump discontinuation timing on delivery outcomes in preeclamptic parturients

摘要

目的 探讨硬膜外分娩镇痛泵关闭时机对子痫前期(PE)产妇分娩结局的影响.方法 选择2021年9月至2023年9月西安交通大学第一附属医院收治的109例子痫前期产妇为研究对象,根据患者意愿分为A组(宫口开大8cm时暂时关闭镇痛泵,n=56)和B组(宫口开全后关闭镇痛泵,n=53),待胎儿娩出后重新开启镇痛泵.采用倾向性评分匹配法,按照1∶1的比例进行匹配,最终A组和B组各包含50例患者,观察两组不同产程时长、氧化应激水平、镇痛介质水平和不良结局发生率.多因素Cox回归分析关闭镇痛泵时机对产妇应激指标及镇痛介质的影响,二元Log-binomial回归计算母婴不良结局发生率的相对危险度(RR).结果 A组产妇第二产程和总产程的时长均短于B组(t值分别为2.04、2.11,P<0.05);A组第二产程的过氧化氢酶(CAT)、谷胱甘肽(GSH)、超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)水平高于B组,丙二醛(MDA)和一氧化氮(NO)水平低于B组,差异有统计学意义(t值介于2.14~3.24之间,P<0.05);A组第二产程的P物质(SP)、前列腺素E₂(PGE₂)和5-羟色胺(5-HT)水平均低于B组,差异有统计学意义(t值介于2.66~5.45之间,P<0.05);与B组比较,A组的新生儿综合不良结局降低(χ²=4.68,P<0.05),发生胎膜早破、胎盘粘连、羊水异常的情况显著降低(χ²值分别为4.68、5.66、4.68,P<0.05).结论 子痫前期产妇分娩时,选择宫口开大8cm时暂时关闭镇痛泵,可以减少第二产程及总产程的时间,降低第二产程的氧化应激损伤,缓解第二产程的疼痛,降低新生儿不良结局、胎膜早破和羊水异常的风险.

Abstract

Objective To investigate the effect of the timing of epidural labor analgesia pump discontinuation on delivery outcomes in parturients with preeclampsia (PE). Methods A total of 109 preeclamptic parturients admitted to the First Affiliated Hospital of Xi′an Jiaotong University from September 2021 to September 2023 were enrolled. Based on their preferences, they were divided into Group A (epidural labor analgesia pump temporarily discontinued at 8 cm cervical dilation, n=56) and Group B (epidural labor analgesia pump discontinued after full cervical dilation, n=53). After fetal delivery, the epidural labor analgesia pump was restarted. Propensity score matching was performed at a 1∶1 ratio, resulting in 50 patients in each group. The duration of labor stages, oxidative stress levels, pain-related mediators, and incidence of adverse outcomes were compared between the two groups. Multivariate Cox regression was used to assess the impact of pump discontinuation timing on stress and analgesic indicators, and binary log-binomial regression was used to calculate the relative risk (RR) of maternal and neonatal adverse outcomes. Results The duration of the second stage and total labor was significantly shorter in Group A than in Group B (t=2.04 and 2.11, respectively, P<0.05). During the second stage of labor, Group A exhibited higher levels of catalase (CAT), glutathione (GSH), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px), as well as lower levels of malondialdehyde (MDA) and nitric oxide (NO) compared to Group B, with statistically significant differences (t ranged from 2.14 to 3.24, all P<0.05). Additionally, Group A had significantly lower levels of substance P (SP), prostaglandin E ₂ (PGE ₂), and 5-hydroxytryptamine (5-HT) during the second stage (t ranged from 2.66 to 5.45, all P<0.05). Compared to Group B, the incidence of composite neonatal adverse outcomes was reduced in Group A (χ ²=4.68, P<0.05), with significantly lower rates of premature rupture of membranes, placental adhesion, and amniotic fluid abnormalities (χ ²=4.68, 5.66 and 4.68, respectively, P<0.05). Conclusion For parturients with preeclampsia, temporarily discontinuing the epidural labor analgesia pump at 8 cm cervical dilation can shorten the second stage and total labor duration, reduce oxidative stress injury, alleviate pain in the second stage, and decrease the risk of neonatal adverse outcomes, premature rupture of membranes, and amniotic fluid abnormalities.

关键词

镇痛泵 / 关闭时机 / 子痫前期 / 产程 / 分娩结局

Key words

epidural analgesia pump / discontinuation timing / preeclampsia / labor process / delivery outcome

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