| Objective:Compare and analyze the VAS scores,process of labor,complications during delivery and neonatal outcome of primiparas with and without epidural analgesia,to explore the safety and effectiveness of epidural analgesia.Methods:Collected 140 primiparas who gave birth in the obstetrics department of Shandong University Second Hospital from September 2020 to November 2020,and excluded those who failed to vaginal delivery or precipitate labor,divided into analgesia group 70 cases and control group 70 cases according to the principle of voluntary epidural block.Use independent sample t test,Mann-Whitney U test,χ2 test,Spearman correlation analysis method to compare the basic condition of pregnant women,VAS score,modified Bromage score,the intervention rate of oxytocin,amniotic state,postpartum hemorrhage,catheterization,postpartum urinary retention,and Apgar score of newborn,umbilical artery blood analysis,and IL-6,TNF-α,IL-1βand other data.Draw labor curve to study the effect of epidural analgesia on uterine orifice dilation and labor time.Results:1.Before epidural analgesia,the VAS score of analgesia group was 8(7～8)points,and control group was 7(6～8)points.No statistical difference between two groups(P>0.05).At the end of the uterine opening and the second stage of labor,the VAS score of analgesia group were 3 points(2～3 points)and 2 points(2～3 points)separately.The pain were lower than control group[9 points(9～10 points)and 6 points(5～6 points)],the difference was statistically significant(P<0.05).The modified Bromage scores of both groups were 0.2.The total duration of labor in analgesia group[9.59(7.60～13.05)h]was longer than that in control group[8.05(7.05～9.10)h].Among them,the first stage of labor[8.75(6.46～11.04)h]and the second stage of labor[1.01(0.75～1.62)h]in analgesia group were longer than those in the normal delivery group[7.09(6.25～8.00)h;0.76(0.38～1.10)h],the difference was statistically significant(P<0.05).The median and the 95th percentile for every 1cm progress during the incubation period with epidural analgesia were 1.6(3.2)h and 1.4(2.7)h respectively,and were 1.5(3.2)h and 1.2(2.6)h without epidural analgesia,there was no statistically significant difference in the progress(P>0.05),while the progress of analgesia group in the active phase[1.1(2.3)h;1.0(2.2)h;0.6(1.1)h;0.4(0.8)h;0.3(0.6)h]was significantly slower than control group[1.0(2.1)h;0.8(1.7)h;0.5(1.0)h;0.3(0.5)h;0.2(0.4)h],the difference was statistically significant(P<0.05).3.The intervention rate of oxytocin in analgesia group[35 cases(49.6%)]was higher than that of control group[15 cases(21.6%)],and the difference was statistically significant(P<0.001).There were 7 cases(20%)in analgesia group used oxytocin in incubation period,28 cases(80%)used oxytocin in active phase,5 cases(33%)and 10 cases(67%)in control group.The rate in the active phase of analgesia group was higher,but the difference was not statistically significant(P>0.05).And there was no statistically significant difference in catheterization,postpartum urinary retention,postpartum hemorrhage,midwifery ratio,and amniotic fluid status(P>0.05).4.The Apgar scores of analgesia group were 9.87±0.66,9.96±0.36,and 9.97±0.17 at 1 min,5 min,and 10 min respectively.Control group was 9.97±0.17,9.97±0.17,9.97±0.24 respectively.The difference was not statistically significant(P>0.05).The pH of the umbilical artery blood in two group were 7.29±0.02,7.28±0.02,respectively;PCO2 were 46.9±7.4mmHg,46.6±5.3mmHg,and PO2 were 19.2±3.3mmHg,18.0±4.1mmHg;Lac is 3.33±0.19mmol/L,3.30±0.20mmol/L;IL-6 is 5.67±3.86pg/ml,5.03±2.03pg/ml;TNF-α is 3.05±3.55pg/ml,2.17±2.06pg/ml;IL-1β was 2.92±0.27pg/ml,2.80±0.2pg/ml,the difference was not statistically significant(P>0.05).Through Spearman analysis,cord blood pH and lactic acid value are related to the length of the second stage of labor,and the difference is statistically significant(P<0.05).The pH value is negatively correlated with the duration of the second stage,with a correlation coefficient of-0.38,and the lactic acid value is positively correlated with the duration of the second stage of labor,with a correlation coefficient of 0.54.But there was no significant correlation with the length of the first stage and the weight of the newborn(P>0.05).Conclusion:1.Epidural analgesia can effectively reduce the VAS score of the parturient during labor.2.Epidural analgesia can affect the progress of active stage of labor,and prolong the time of the first and second stages of labor,but they still within the normal labor process.Epidural analgesia will increase the intervention rate of oxytocin.The intervention rate in the active phase is significantly higher than that in the incubation phase,but it does not increase the occurrence of midwifery,postpartum hemorrhage and postpartum urinary retention.3.Epidural analgesia has no effect on the Apgar score,cord blood gas analysis and the concentration of TNF-α,IL-1β,and IL-6 in newborns,and will not lead to adverse neonatal outcomes. |
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