硬膜外麻醉減痛對於生產歷程與結果的影響

Effects of Epidural Analgesia on the course of childbirth and outcome

許淳芳(Chun-Fang Hsu)

指導教授 ： 李淑杏

中山醫學大學/護理學院/護理研究所/碩士(2016年)

摘要

背景:分娩是一種自然的生理現象，也是婦女生命中極為重要的經驗，而產痛被婦女視為難以忍受的疼痛及痛苦的經歷，對於情緒與心理皆有立即性及長遠的影響，因此有效減緩產痛對婦女而言極為重要；隨著醫療科技進步，越來越多的婦女於待產時選擇硬膜外麻醉減痛。然而，生產過程中所給予的麻醉止痛藥物對產婦本身與胎兒造成生理的影響，依舊是產婦與醫護人員關心的重要議題。
目的:欲了解硬膜外麻醉減痛對生產歷程與結果的影響。
研究設計:採病例對照法，以病歷回溯方式收集受試者資料，資料來源為中部某醫學中心婦產科，探討硬膜外麻醉減痛對生產歷程與結果的影響。自2014年01月至12月，共收案288人，分為兩組，採用硬膜外麻醉減痛產婦為個案組(154人)，無使用硬膜外麻醉減痛者為對照組(134人)。研究變項含催產素的使用、產程時間、生產方式、陰道裂傷、血壓變化、尿滯留、頭痛、產後出血、胎心率及新生兒Apgar score。所收集資料將以SPSS18.0統計軟體分析，含t檢定、卡方檢定、二元邏輯斯迴歸分析及線性迴歸分析等。
結果:單變項分析結果顯示硬膜外麻醉減痛組與對照組在催產素使用與劑量(待產時)、低血壓、第一及第二產程時間、生產方式、尿滯留及產後解尿方式、新生兒Apgar score達顯著差異，且低血壓僅發生於個案組(7%)。以二元邏輯斯迴歸分析後，個案組使用催產素的勝算比為對照組的2.69倍(OR=2.69，95% CI=1.47-4.93)，達統計上顯著差異(p = .001)、使用器械輔助生產的勝算比為為對照組的2倍(OR=2，95% CI=1.03-4.25)，達統計上顯著差異(p =.04)、發生尿滯留的勝算比為對照組的16.1倍(OR=16.1，95% CI=7.87-33.05)，達統計上顯著差異(p< .005)。線性迴歸分析結果顯示使用硬膜外麻醉減痛者催產素使用劑量較高、第一產程時間及第二產程時間較長，達統計上顯著差異(p ＜ .05)。二組於剖腹生產及新生兒Apgar score變項，統計上均未達顯著差異。
結論:研究結果顯示硬膜外麻醉減痛對胎兒及新生兒無直接不良的影響，是安全有效的減痛方式，另外硬膜外麻醉減痛會誘發低血壓，注射催產素的比例較高及劑量較多，使用器械輔助生產及發生第一、二產程延長、尿滯留的風險明顯增加，研究結果可提供醫護人員臨床照護之參考。

關鍵字

生產 ； 硬膜外麻醉減痛

並列摘要

Background:The labor pain is considered the most excruciating pain and the most painful experience. The level of pain experienced and the effectiveness of painless may influence women’s satisfaction with labor and delivery and may have immediate and long-term emotional and psychological effects. Thus pain relief is an important subject for women in labor. With advance medical technology, more and more women choose epidural analgesia for pain relief. Epidural analgesia is a central nerve blockade technique, which involves the injection of a local an aesthetic into the lower region of the spine close to the nerves that transmit painful stimuli from the contracting uterus and birth canal. However, the anesthetics impact on the maternal and fetal physiology in the childbirth process is always an important issue and concerns by maternal and healthcare.
Objective:The aim of this study was to describe the effects of management of childbirth among women received epidural analgesia.
Design, setting and participants: The study was a case-control study and data were collected via retrospective chart review from an Obstetrics and Gynecology ward in a medical center in midland of Taiwan during 2014.By reviewing medical records in the Obstetrics and Gynecology ward, 288 pregnant women who delivered were included. One hundred and fifty-four women with epidural analgesia were placed in casegroupand 134 women without epidural analgesia were placed in control group. The study variables including oxytocin augmentation, length of labor, mode of delivery, laceration degree, hypotension, urinary retention, postpartum hemorrhage, headache, fetal heart rate and Apgar score of the neonates. Data from this study were analysis using the software package SPSS 18.0 for Windows. Analysis included: student t-test, Chi-Square test、Binary Logistic Regression and Linear Regression analysis.Statistical significance was considered for p<0.05.
Result: After control demographic variables, analysis byBinary Logistic regression and Linear regressionshowed that epidural analgesia was associated with Oxytocin requirement,longer first and second stage of the labor, increased incidence of instrument assisted delivery, risk of urinary retention and induced maternal hypotension. Data on cesarean deliveryand lower Apgar score in the neonates showed no statistic significantly between two groups.
Conclusions:Epidural analgesia is a safe and effective way to reduce pain and no direct adverse effects on the fetus and newborn was found.

並列關鍵字

Childbirth ； Epidural analgesia

參考文獻

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