| According to statistics,in recent years,the rate of cesarean section in China has reached nearly 50%,more than three times the world warning line.One of the important factors is that parturient women cannot bear labor pain.About 60% of primary parturients describe labor pain as extreme or severe pain,which is also closely related to the development of postpartum depression and postpartum chronic pain.Epidural labor analgesia(Labour Epidural Analgesia,LEA)can effectively relieve labor pain and improve maternal satisfaction,but the effects of epidural analgesia formulations with different local anesthetic concentrations on obstetrical outcomes and side effects are uncertain.In particular,fever after analgesia often affects the decision-making of obstetricians and affects the outcome of mothers and infants.For this reason,to find a labor analgesia scheme with very good analgesic effect and little influence on mother and infant,and to analyze and study the effect of labor analgesia with different concentrations of local anesthetic on the outcome of mother and infant,it is of great significance to popularize this technology and ensure the safety of mother and infant,and is likely to become a key countermeasure to reduce the total rate of cesarean section.Objectives:To retrospectively summarize and analyze the effects of epidural labor analgesia with different concentrations of local anesthesia on mothers and newborns,give more reference to reduce the total rate of cesarean section in clinic,and ensure the safety of mothers and infants.Methods:?A retrospective analysis was made of 285 parturients who came to Zhenjiang Fourth people's Hospital for painless delivery from January 2018 to December 2018.285 parturients who met the inclusion criteria were divided into high concentration(0.15%)ropivacaine group(n =194)and low concentration(0.075%)ropivacaine group(n=91)according to the concentration of local anesthesia used for analgesia.?Collect and review the basic clinical data of the two groups(age,gestational week,BMI index,times of abortion,pregnancy hypertension,gestational diabetes,premature rupture of membranes,artificial rupture of membranes,whole blood cell count),labor time,2cm(before labor analgesia),4cm and uterine contraction,analgesia level,VAS score at10min?20min?30min and 1h after analgesia.Delivery outcome(postpartum hemorrhage rate,lateral incision rate,mechanical delivery rate,oxytocin utilization rate,urinary catheterization rate during delivery,conversion cesarean section rate,intrapartum fever),neonatal outcome(neonatal Apgar score).?According to the presence of intrapartum fever,the two groups were divided into fever group(n=157)and control group(n=128).The risk factors of intrapartum fever in parturients with epidural analgesia and the correlation between intrapartum fever and uterine contraction and local anesthetic concentration were analyzed.Results:?There was no statistical difference in age,BMI index,gestational weeks,times of abortion,gestational hypertension,gestational diabetes,premature rupture of membranes,artificial rupture of membranes and whole blood cell count(hemoglobin,white blood cell count,monocyte count,prenatal blood glucose)between the low concentration group and the high concentration group(P>0.05).?There is no statistical difference between the total labor,first labor,second labor and third labor of women in the low concentration group and the high concentration group(P<0.05).?There was no statistical difference in the uterine contraction between the low concentration group and the high concentration group when the uterine mouth was enlarged by 2cm(before labor analgesia)between the low concentration group and the high concentration group(P>0.05).Compared with the low concentration group,the duration of uterine contraction and the interval time of uterine contraction in the high concentration group were significantly longer than those in the low concentration group(P<0.001).Compared with the low concentration group,the duration and interval of uterine contraction were shorter and longer in the high concentration group(P <0.001).?Compared with the low concentration group and the high concentration group,the analgesia level of the high concentration group was higher than that of the low concentration group(P<0.05).?Comparing the pain levels of the two groups,there was no significant difference between the two groups before analgesia(P> 0.05);At 10 min ? 20 min ? 30 min and 1h after analgesia,the pain in the high-concentration group was significantly lower than that in the low-concentration group(P <0.05).The median VAS scores before and after analgesia in the low and high concentration groups were both 10 points;although the median VAS scores in the high concentration group were lower than those in the low concentration group at 10,20,and 30 minutes after analgesia,but At 1h,the median VAS scores of both groups were 3 points,indicating that although the low-level analgesic intensity is slightly slower at higher levels,it can still achieve an analgesic effect comparable to the high-level concentration over time.?There was no significant difference in the amount of postpartum hemorrhage between low concentration group and high concentration group(P>0.05),and there was no significant difference in lateral cutting rate between low concentration group and high concentration group(P>0.05).There was no significant difference in mechanical delivery rate between low concentration group and high concentration group(P>0.05).Compared with the low concentration group,the utilization rate and dosage of oxytocin in the high concentration group were significantly higher than those in the low concentration group(P<0.05),and the rate of cesarean section in the high concentration group was significantly higher than that in the low concentration group(P<0.05).The rate of cesarean section in the high concentration group was significantly higher than that in the low concentration group(P<0.05).There was no significant difference in prenatal body temperature between high concentration group and low concentration group(P>0.05).The fever rate between labor,the body temperature after analgesia and the increase of body temperature after analgesia in the high concentration group were significantly higher than those in the low concentration group(P<0.05).?After birth of 1min and 5min,there was no significant difference in Apgar score between low concentration group and high concentration group(P>0.05).?After re-grouping,the uterine contractions in the febrile group and the control group were compared.The results showed that there was no significant difference in uterine contractions between the two groups when the uterine orifice was enlarged with 2cm(before labor analgesia)(P>0.05).Compared with the control group,the duration of contractions and the interval between contractions were shortened and the interval between contractions was shortened(P <0.05).82.17% of the women in the fever group used high-concentration(0.15%)ropivacaine during epidural analgesia,while the control group had a high-concentration(0.15%)ropivacaine use rate is only 50.78%.Comparing the uterine contractions of the fever group and the control group at the same local anesthetic concentration,there was no difference in the duration and interval of uterine contractions between the femoral group and the control group at the uterine opening 4cm and the full opening(P> 0.05).?Correlation analysis showed that the concentration of local anesthesia(OR=0.256,95%CI:0.147-0.466)was an independent risk factor for intrapartum fever in parturients with epidural analgesia(P<0.05).Conclusion:1.The use of low-concentration(0.075%)local anesthetics during epidural labor analgesia can greatly reduce the adverse effects on maternal and ensure the safety of mothers and infants on the premise of ensuring the analgesic effect.2.The level of local anesthetic concentration is an independent risk factor for postpartum fever after maternal analgesia.3.The weakening of maternal contractions during epidural labor analgesia with interpartum fever was not associated with fever,but was positively correlated with epidural local anesthetic concentration. |
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