曾慧倩?张慧珠?何平?赖毓冕

    【摘要】目的 研究低濃度局部麻醉药物分娩镇痛在第二产程出现可疑型电子胎心监护(EFM)时对母儿近期结局的影响。方法 选择定期产检、单胎头位足月分娩且第二产程出现可疑型EFM的1179例产妇为研究对象，通过倾向性评分匹配选取使用分娩镇痛的232例产妇为镇痛组，未使用分娩镇痛的232例产妇为非镇痛组，比较2组产妇及新生儿近期结局。结果 镇痛组中产妇的产钳助产率为51.3%，新生儿住院率为13.8%，新生儿轻度酸血症发生率为53.4%，均高于非镇痛组，且住院时间也比非镇痛组延长(P均 0.05)，2组新生儿ICU入住率比较差异亦无统计学意义(P > 0.05)。第二产程可疑型EFM的类型包括频发早期减速、频发变异减速、持续胎心过速和延长减速，在镇痛组及非镇痛组的分布比较差异无统计学意义(P > 0.05)。Logistic回归分析显示分娩镇痛增加产钳助产及新生儿轻度酸血症的风险(OR分别为2.412、1.733，P均 0.05)。结论 低浓度局部麻醉药物分娩镇痛第二产程出现可疑型EFM时需对产妇积极处理，低浓度局部麻醉药物分娩镇痛不会增加母亲及新生儿的严重不良结局。

    【关键词】分娩镇痛;第二产程;电子胎心监护;不良结局;麻醉药物;助产

    Effect of low-dose epidural analgesia on maternal and fetal outcomes of women with nonreassuring fetal heart rate tracing in the second stage of labor： a case-control study based on propensity score-matched analysis Zeng Huiqian， Zhang Huizhu， He Ping， Lai Yumian. Department of Gynecology and Obstetrics， Guangzhou Women and Childrens Medical Center， Guangzhou 510623， China

    Corresponding author， Lai Yumian， E-mail： lym7105@ 126. com

    【Abstract】Objective To evaluate the effect of epidural analgesia using low-concentration local anesthetics on the short-term maternal and fetal outcomes of the women with nonreassuring fetal heart rate tracing in the second stage of labor. Methods 1179 pregnant women who had regular prenatal visit were recruited into the study. All participants were singleton term vaginal deliveries with cephalic presentation and had nonreassuring fetal heart rate tracing during the second stage of labor. After propensity score-matched analysis ......