| Objectives:To observe epidural analgesia in different stages of labor,and to analyze the effect of epidural analgesia on labor progress,delivery mode,postpartum hemorrhage and the neonate safety.To evaluate the effect and safety of epidural analgesia in the whole stage of delivery.Methods:1.Data sources:A total of 120 parturients with epidural analgesia for vaginal delivery were selected between Oct.1st.2015 to Oct.31st.2016 from American-Sino Women's&Children's Hospital in Shanghai.Inclusion criteria:All the cases were selected by the criteria as follows:singleton,vertex presentation,full term gestation in labor(between 37 weeks to 41+6 weeks),no related obstetrics complications,no other medical situation which may affect the study,no contraindications for epidural anesthesia and normal body temperature,etc.Exclusion criteria:birth canal abnormality,macrosomia,fetal growth restriction and premature rupture of membranes more than 24 hours were all excluded.These 120 parturients were randomly divided into 4 groups(30 cases in each group).Group A:analgesia was given from the beginning of labor and continued after cervix complete dilation.Group B:analgesia was given from the beginning of labor until cervix complete dilation.Group C:analgesia was given from 3-5 cm cervical dilation and continued after cervix complete dilation.Group D:analgesia was given from 3-5 cm cervical dilation until cervix complete dilation.2.Methods of analgesia:After parturient enters labor room,measured vital signs(blood pressure,heart rate,breathing rate,pulse),monitor fetal heart rate,uterine contraction intensity,establish vein channel.First,the parturient were required to take a left lateral position.Second,the puncture was performed at L2-3 or L3-4.Next,a tube was placed towards the headend of the parturient and then parturient was required to take a horizontal faceup position in bed.1?1.5%lidocaine 3ml was injected into the epidural space as an experimental dose.After the level of anesthesia had been stabilized,the PCEA pump was connected to the body.The analgesic within the PCEA pump was a mixture liquid of 0.1%ropivacaine,0.5ug/ml sufentanil and 100ml normal saline.The initial dosage was 6ml,the constant dosage was 6ml per hour,and the self-controlling dosage was 6ml with a lockout interval of 15 minutes.The parturient would press the button to take drugs by herself if the analgesia was not enough for her.3.Indicators of observation:The following were recorded:The age,height,weight,gestational week,parity of the parturient,the weight of the neonate,the duration of the first and second stage of labor,oxytocin application,mode of delivery,postpartum hemorrhage in 2 hours,one-minute and five-minute Apgar scores(? 8 normal,? 4 mild asphyxia,<4 severe asphyxia),pain intensity evaluated using VAS score(a score of 0 represented no pain,and a score of 10 indicated severe pain.0-3 scores was satisfied,4-5 scores was basically satisfied and 6-10 scores was not satisfied).4.Statistical analysis:Adopted SPSS22.0 software to complete data analyze,measurement data were demonstrated in the format of mean ± standard deviation,comparison among group adopt one-way analysis of variance,and Levene was adopted for the homogeneity test of variance.The enumeration data was tested by the Chi-square test.If P<0.05,the differences are statistical significance.Results:The data of 120 cases were all collected.2 of them was excluded due to difficulty in catheterizing and epidural analgesia failed.Eventually,118 cases in all completed this research.1.Differences of age,height,weight,gestational week,parity and weight of neonate of 4 groups had no statistical significance(P>0.05).2.The duration of the first stage of labor of group A and group B(analgesia since the beginning of labor)was shorter than that of group C and group D(analgesia from active stage),the differences of which had statistical significance(P<0.05).3.The duration of the second stage of labor in four groups had no significant difference(P>0.05).4.The differences of postpartum hemorrhage in 2 hours,the caesarean rate and forceps rate of 4 groups had no statistical significance(P>0.05).5.The rate of oxytocin application in group A and group C(analgesia continue in the second stage)was larger than that in group B and group D(analgesia stop in the second stage),the difference of which had statistical significance(P<0.05).6.The difference of the neonatal asphyxia rate in group A and group C(analgesia continue in the second stage)had no statistical significance with that in group B and group D(analgesia stop in the second stage)(P>0.05).7.The difference of the analgesia satisfaction in 4 groups had statistical significance(P<0.05),and the effect of analgesia in group A(analgesia in the whole labor stage)was the best.Conclusions:1.Implementing of epidural anesthesia in the whole labor course can shorten the first stage of labor,and does not significantly affect the second stage of labor.2.Continuous analgesia during the second stage of labor increases the rate of oxytocin application,but it does not increase the cesarean rate and forceps rate.3.Implementing of epidural delivery analgesia in the whole labor course has no significantly affect postpartum hemorrhage and the neonatal asphyxia rate.4.Epidural anesthesia is a safe way of delivery analgesia.Implementing of epidural delivery analgesia in the whole labor course has got a satisfying analgesia effect,and it does not affect the delivery outcome. |
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