探讨硬膜外分娩镇痛对单胎头位初产妇妊娠结局的影响。

选择2013年1月至12月，于延安大学附属医院住院分娩，并要求使用硬膜外分娩镇痛的102例单胎头位初产妇为研究对象，纳入研究组。采用简单随机抽样方法，选取同期于延安大学附属医院住院分娩，但未使用硬膜外分娩镇痛的102例单胎头位初产妇纳入对照组。对研究组初产妇经阴道分娩时，采用连续硬膜外注射芬太尼进行分娩镇痛，对照组初产妇经阴道分娩未采用任何镇痛措施，若2组单胎头位初产妇中转剖宫产术分娩，则按照硬膜外麻醉处理。统计学比较2组单胎头位初产妇规律性宫缩时子宫颈扩张度、第一及第二产程时间、《数字评价量表(NSR)》评分、胎膜破裂情况、催产素使用情况、分娩方式，以及新生儿出生体重及出生后1、5 min时Apgar评分等指标。2组单胎头位初产妇的年龄、体重、孕龄和身高等基本临床资料比较，差异均无统计学意义(P>0.05)。

①研究组单胎头位初产妇第一产程时间较对照组显著缩短，并且差异有统计学意义(t＝3.46，P＝0.003)；2组单胎头位初产妇第二产程时间和规律性宫缩时宫口扩张度分别比较，差异均无统计学意义(P>0.05)。研究组单胎头位初产妇硬膜外分娩镇痛实施30 min时，NSR评分和疼痛程度分级，均显著低于对照组(规律性宫缩时)，差异均有统计学意义(Z＝2.45，P＝0.021；χ²＝8.84，P＝0.012)。②研究组单胎头位初产妇自然分娩率显著高于对照组，剖宫产术分娩率显著低于对照组，差异均有统计学意义(χ²＝13.33、13.60，P<0.001)。2组单胎头位初产妇产钳助产率、催产素使用率和胎膜破裂率分别比较，差异均无统计学意义(P>0.05)。③2组单胎头位初产妇分娩新生儿的出生体重及出生后1、5 min时Apgar评分分别比较，差异均无统计学意义(P>0.05)。

硬膜外分娩镇痛可降低单胎头位初产妇分娩疼痛程度和剖宫产术分娩率，缩短第一产程，未导致新生儿不良妊娠结局的发生。

To investigate the influence of epidural analgesia in pregnancy outcomes of single birth primipara with normal fetal position.

From January to December 2013, a total of 102 cases of single birth primiparas with normal fetal position who requested epidural analgesia in Yan′an University Hospital were enrolled into study group. And another 102 cases of single birth primiparas with normal fetal position who did not receive epidural analgesia in Yan′an University Hospital during the same period were selected as control group by simple random sampling method. The single birth primiparas with normal fetal position in study group were treated with continuous epidural injection of fentanyl for labor analgesia during vaginal delivery. While the single birth primiparas with normal fetal position in control group was not treated with any analgesia during vaginal delivery. If the single birth primiparas with normal fetal position in 2 groups turned to cesarean delivery, they were treated by epidural anesthesia. The cervix dilatation at the time of regular contractions, duration of the first stage of labor, duration of the second stage of labor, numeric rating scale (NRS) score, membrane rupture, usage of oxytocin, mode of delivery, neonatal birth weight and 1, 5 min Apgar scores after birth between the two groups were compared by statistical methods. There were no statistical differences between two groups in the age, body weight, gestational age and body height and so on (P>0.05).

①The duration of first stage of labor in study group was significantly lower than that in control group, and the difference was statistically significant (t=3.46, P=0.003). There were no statistical differences between two group in duration of the second stage of labor and cervix dilatation at the time of regular contractions (P>0.05). The NRS score and pain classification at the time of epidural analgesia for 30 min in study group both were obviously lower than those in control group (at the time of regular uterine contractions), and both the differences were statistically significance (Z=2.45, P=0.021; χ²=8.84, P=0.012). ②The rate of spontaneous delivery was obviously higher than that in control group, while the rate of the cesarean delivery was obviously lower than that in control group, and both the differences were statistically significant (χ²=13.33, 13.60; P<0.001). But there were no significant differences between two groups in the rates of the forceps delivery, use of oxytocin and membrane rupture (P>0.05). ③There were no statistically significant differences between two groups in the neonatal birth weight, 1, 5 min Apgar scores after birth (P>0.05).

Epidural analgesia can reduce the labor pain and the rate of cesarean delivery and shorten the duration of first stage of labor in single birth primiparas with normal fetal position, at the same time it does not lead to the occurrence of neonatal adverse pregnancy outcomes.