【摘要】 【目的】探讨腰硬联合麻醉(CSE)分娩镇痛产程中转剖宫产的指征及影响因素。【方法】选择2009年1月至2013年12月有阴道试产条件行腰硬联合麻醉分娩镇痛转剖宫产的428例产妇为研究组,同期未行分娩镇痛阴道试产转剖宫产的430例产妇为对照组,分析比较两组的剖宫产指征及影响因素。【结果】两组的剖宫产指征依次为:头位难产、胎儿窘迫、社会因素,瘢痕子宫,研究组的头位难产率高于对照组(P<0.01),而胎儿窘迫、社会因素为指征的剖宫产率低于对照组(P<0.05、P<0.01);两组头位难产的前3位影响因素是:持续性枕后位、持续性枕横位,头盆不称(枕前位);研究组胎儿窘迫的前3位影响因素是脐带因素、绒毛膜羊膜炎,妊娠合并症,对照组胎儿窘迫的前3位影响因素是脐带因素、不明原因的羊水混浊,绒毛膜羊膜炎;研究组的新生儿窒息率低于对照组(P<0.05),缩宫素使用率高于对照组(P<0.01)。【结论】腰硬联合麻醉分娩镇痛可以降低胎儿窘迫及新生儿窒息的发生率,但头位难产的风险增高,加强产程的观察、处理以及镇痛方法的改进可能是降低剖宫产率的有效方法。更多还原

【Abstract】 【Objective】 To investigate the indications of having to transform from labor analgesia by means of combined spinal epidural who selected vaginal delivery into cesarean section. 【Methods】 During January 2009 to December 2013, 428 cases were collected as research group who were able for vaginal delivery and chosen combined spinal epidural and 430 cases contemporaneously of vaginal delivery at first without labor analgesia also transformed into cesarean section for control group, the indications and factors of cesarean section of two groups were analyzed and compared. 【Results】 The top four indications of two groups for cesarean section successively were: head dystocia, fetal distress, social factors and scarred uterus. For research group, the head dystocia rate was higher than that in control group(P < 0.01), but cesarean section rates due to fetal distress and social factors were lower than those in control group(P < 0.05 and P < 0.01). As for head dystocia in two groups, the top three factors were: persistent occiput posterior position, persistent occiput transverse position, cephalopelvic disproportion(occipito-anterior position). The top three influence factors of fetal distress in research group successively were the umbilical cord factors, chorioamnionitis, pregnancy combined diseases, while in control group it seemed to be umbilical cord factors, unidentified amniotic fluid turbidity and chorioamnionitis.Besides, neonatal asphyxia rate of research group was lower than that in control group(P < 0.05), but the oxytocin usage rate was higher than that of control group(P < 0.01). 【Conclusions】 It seemed that combined spinal epidural for labor analgesia could reduce the incidence of fetal distress and neonatal asphyxia, but increase the risk of head dystocia. Strengthening observation and handling labor abnormalities, improving analgesia method may be effective ways to reduce the rate of cesarean section.更多还原