Epidural anestezi doğumun evrelerini ve yenidoğan bebeği nasıl etkiler? 90 olgunun prospektif analizi.

Öz

Amaç: Epidural anestezi (EA), ağrının azaltılmasında ve doğum sırasında tamamen ortadan kaldırılmasında en etkili yöntemdir. Bu çalışmanın amacı, EA'nın doğum sürecinin birinci ve ikinci kısmı üzerindeki etkisini ve EA'nın yenidoğan ve anne üzerindeki etkisini belirlemektir. Yöntem : Hastanemizde toplam 153 primipar gebe seçildi. Epidural doğum analjezisini kabul edip etmemesine göre çalışma grubu 90 primipar gebe, kontrol grubun 63 primipar olmak üzere iki ayrı gruptan oluşturuldu. Her iki grup da vajinal doğum yaptı. Anestezik olarak 18 G kateterlerle Bupivakain (%0,25 veya %0,125) +2µg/ml fentanil kullanıldı. Uygulama seviyesi omurganın L2-L3 seviyesi idi. Dilatasyon ve efesman düzeyi, doğumun birinci, ikinci ve üçüncü evrelerinin süresi, primiparların anormal durumu ve komplikasyonları değerlendirildi. Bulgular: Analiz sonucunda çalışma grubundaki gebelerin bebeklerinin doğum ağırlıkları kontrol grubuna göre anlamlı olarak yüksek bulundu (p<0.05). Analjeziden 30 dakika sonra çalışma grubunun NRS skoru kontrol grubundan daha düşüktü (P<0.001). Çalışma grubundaki bebek Apgar skorları kontrol grubuna göre anlamlı derecede yüksekti (p<0,001). Çalışma grubunda evre I için ortalama süre 2.27 ± 1.26 saatti ve kontrol grubuna göre anlamlı derecede düşüktü (p <0.001). Tam dilatasyondan doğuma kadar geçen süre (evre II) çalışma grubunda kontrol grubuna göre anlamlı olarak daha uzun bulundu (p<0,001). Çalışma grubu ve kontrol grubu arasında doğum sonu kanama, baş dönmesi ve kusma miktarında komplikasyonlar açısından anlamlı fark yoktu. Çalışma grubunda idrar retansiyonu insidansı kontrol grubuna göre daha yüksekti (p<0,05). Sonuç: Bu çalışmada epidural anestezi uygulamasının doğum süresini kısalttığı, güvenli olduğu, hastayı rahat ettirdiği ve yenidoğan üzerinde herhangi bir olumsuz etkisi olmadığı görülmektedir.

Anahtar Kelimeler

• Epidural anestezi
• vajinal doğum
• neonatal sonuçlar

How can epidural anestesia affect the delivery stages and a newborn infant ? The prospective analysis of 90 cases

Öz

Objective: Epidural anaesthesia (EA) is the most efficient method of pain reduction and its total elimination during delivery. The aim of this study was to establish an influence of EA on the first and the second part of delivery process and the effect of EA on the newborn and mother. Method : A total of 153 primiparas in our hospital were selected and divided into two groups according to whether they accepted epidural labor analgesia, including 90 cases in the study group and 63 cases in the control group. Both groups had vaginal delivery. As anaesthetic, Bupivacain (0,25% or 0, 125%) +2µg/ml fentanyl was used by the 18 G catheters. Level of application was L2-L3 part of spine. Dilatation and efesman level, duration of the first, second and third stages of labor, the abnormal situation and complications of primiparas were evaluated. Result: As a result of the analysis the birth weight of the babies of the pregnant women in the the study group was significantly higher than the control group (p <0.05). The study group’s NRS score was lower than that of the control group at 30 min after analgesia (P<0.001). The Apgar scores of the babies in the study group was significantly higher than the control group (p <0.001). The mean time for stage I in the study group was 2.27 ± 1.26 hours and was significantly lower than the control group (p <0.001). The time from full dilatation to delivery (stage II) was found to be significantly longer in the study group than in the control group (p<0.001). In terms of complications, there was no significant difference in the amount of postpartum haemorrhage, dizziness and vomiting in the study group and control group. The incidence of urinary retention in the study group is higher than that in the control group (p <0,05). Conclusion: In this study, the application of epidural anaesthesia seems to shorten the duration of delivery, be safe, make the patient comfortable, and has no any adverse effects on newborns.

Anahtar Kelimeler

• Epidural anesthesia
• vaginal delivery
• neonatal outcomes

Kaynakça

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