Analysis Of Influencing Factors Of Epidural Analgesia For Conversion To Cesarean Section Following Epidural Labor Analgesia

Background of the study:Epidural analgesia is the most effective way to relieve labor pain.When a delivery patient requires a Caesarean section(CS),a previously placed epidural catheter can be used to provide surgical anesthesia with additional anesthesia medications.But not all patients can successfully complete vaginal delivery by cesarean section through this method,the specific reasons are not clear.At present,for such measures after the failure of additional drug anesthesia,there are reports of studies,such as re-performing intraspinal puncture,performing lumbar anesthesia or epidural anesthesia,or directly performing general anesthesia with endotracheal intubation.Methods:According to the inclusion and exclusion criteria,clinical data of 350 parturiants who received epidural analgesia and cesarean section in our hospital from August 2021 to August 2022 were retrospectively collected.The results of epidural analgesia and caesarean section were divided into three groups:excellent group(191 cases),good group(63 cases)and poor group(96 cases).Collect clinical data of patients.The three groups of maternal parity,epidural administration,hypotension,skin resection heart rate increased 20 Times per minute,classification of urgency of caesarean section,artificial rupture of water,preoperative fever,amniotic fluid turbidity,American Society of Anesthesiologists(ASA)classification,neonatal blood gas,pre-anesthetic use of oxytocin,age,gestational age at delivery,body mass index(BMI),duration of epidural administration from the beginning of surgery,duration of surgery from the beginning of surgery to fetal delivery,total duration of surgery,T0 at patient’s entry Heart rate,heart rate at the beginning of surgery,systolic blood pressure at the beginning of surgery,diastolic blood pressure at the beginning of surgery,systolic blood pressure at the beginning of surgery,diastolic blood pressure at the beginning of surgery,size of the uterine orifice before surgery,amount of blood loss,duration of labor analgesia,size of the uterine orifice before surgery,pain score,Apgar at 1,5 and 10 minutes after birth Score,body weight,length of stay,further multiple logistic regression analysis of epidural labor analgesia transfer cesarean section of the anesthetic effect of influencing factors.Results:There was no significant difference in age,gestational age and BMI among the three groups,P>0.05.In the three groups,parity,epidural administration,hypotension,heart rate increase of 20 times/min during dermectomy,urgency classification of cesarean section,artificial water rupture,preoperative fever,amniotic fluid,ASA classification,duration of epidural administration to the start of operation,duration of operation to fetal delivery,total duration of operation,and T0 when the patient entered the room There were no statistically significant differences in heart rate,heart rate at the beginning of surgery,systolic blood pressure at the beginning of surgery,diastolic blood pressure at the beginning of surgery,diastolic blood pressure at the beginning of surgery,blood loss,pain score and length of stay in the three groups(P>0.05).There were statistically significant differences in labor analgesia duration and preoperative uterine orificum size among the three groups,P<0.05;the labor analgesia duration and preoperative uterine orificum size of the poor effect group were significantly lower than those of the good effect group and the good effect group,and the difference was statistically significant;P<0.05;the labor analgesia duration and preoperative uterine orificum size of the good effect group were lower than those of the good effect group,but the differences were not statistically significant.P>0.05.There were no significant differences in neonatal body weight,Apgar score at 1,5 and 10 minutes after birth and blood gas among the three groups(P>0.05).With good and poor anesthetic effect as dependent variable and poor anesthetic effect as control,the above univariate analysis difference index was used as factor and covariable to analyze the influencing factors of anesthetic effect by multiple logistic regression.The results showed that the duration of labor analgesia and the size of the uterine orifice before anesthesia were the risk factors for better anesthesia effect,P<0.05,and no use of oxytocin before anesthesia was the protective factor for better anesthesia effect,P<0.05.The duration of labor analgesia was the risk factor for good anesthesia effect(P<0.05).No use of oxytocin before anesthesia was a protective factor for good anesthesia effect,P<0.05,with statistical significance.With the best anesthesia effect as the control,the duration of labor analgesia and the size of the uterine orifice before anesthesia were the protective factors for poor anesthesia effect,P<0.05,and no use of oxytocin before anesthesia was the risk factor for poor anesthesia effect,P<0.05,with statistical significance.Conclusions:The duration of labor analgesia,the size of uterine orifice before anesthesia,and the use of oxytocin before anesthesia are closely related to the anesthesia effect of labor analgesia during delivery of caesarean section.The duration of labor analgesia and the size of uterine orifice before anesthesia are independent risk factors for anesthesia effect.In clinical practice,attention should be paid to the selection of preoperative uterine mouth size,labor analgesia duration,so as to improve the effect of intraoperative anesthesia and reduce the occurrence of adverse events.