【摘要】 目的探讨初产妇产程中腰硬联合镇痛(combined spinal-epidural analgesia,CSEA)是否增加急诊剖宫产的风险。方法选择2012年1月至2014年12月住院分娩的进行阴道试产的单胎头位足月初产妇3 456例,其中1 786例要求分娩镇痛并接受CSEA者为镇痛组,1 670例无镇痛者为对照组。比较两组孕产妇的分娩方式、缩宫素使用、产程时间和新生儿结局等临床资料。并采用多因素logistic回归模型分析控制混杂变量后的急诊剖宫产与CSEA的相关性。结果 3 456例孕产妇中,急诊剖宫产338例(9.2%),其中镇痛组剖宫产率(12.3%,219/1 786)与对照组(7.1%,119/1 670)比较,差异有统计学意义(P<0.001)。急诊剖宫产指征:产程时间延长133例,胎头位置异常114例,宫颈扩张异常12例,胎儿窘迫79例。镇痛组难产率(9.5%,169/1786)和对照组(5.4%,90/1 670)比较,差异有统计学意义(P<0.001);镇痛组胎儿窘迫发生率(2.8%,50/1786)和对照组(1.7%,29/1 670)比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄、身高、胎儿体质量、入产房时宫口扩张大小、羊水污染和产时CSEA是急诊剖宫产的独立危险因素(P<0.05);CSEA增加剖宫产风险的OR值为1.427(95%CI:1.110~1.834)。结论 CSEA可能增加了产时急诊中转剖宫产的风险,除胎位异常和胎儿窘迫外,年龄、身高、胎儿体质量和入产房时宫口扩张大小与剖宫产密切相关。更多还原

【Abstract】 Objective To determine whether combined spinal-epidural analgesia(CSEA)during labor increased the rate of emergency cesarean section(CS) for Chinese nulliparous women. Methods A retrospective, observational study was conducted from January 2012 to December 2014 and comprised 3 456 term nulliparous women with a singleton fetus in cephalic presentation. Of which, 1 786(51.7%) parturients received CSEA technique for labor pain, and 1 670(48.3%) were not enthusiastic to labor analgesia. Information about mode of delivery, labor duration, oxytocin augmentation and neonatal outcome was obtained. Logistic regression was used to examine independent associations between CSEA and emergency CS after controlling for confounding among the variables. Results 219 in CSEA group(12.3%) and 119 in no analgesia group(7.1%) required emergency CS(P <0.001).Statistically significant differences in the rate of dystocia and fetal distress for CS were observed between the two groups(P < 0.001 and P <0.05). By multivariate regression analysis, the maternal-fetal variables included maternal age, height, birth weight, meconium-stained amniotic fluid, and cervical dilatation at admissionwere significantly associated with emergency CS, and women with CSEA maintained a slight higher risk for it(adjusted OR:1.427; 95% CI:1.110~1.834). Conclusions Among Chinese nulliparous women, use of CSEA for labor pain was associated with higher risks of emergency CS. In addition to fetal malposition and fetal distress, the maternal variables and cervical dilatation at admission were related to CS.更多还原