硬膜外分娩镇痛后暴发痛相关危险因素的临床分析

Clinical analysis of risk factors associated with breakthrough pain after epidural labor analgesia

摘要:

目的 分析硬膜外分娩镇痛后暴发痛的相关危险因素。方法 选取2025年11月—2026年3月于眉山市妇幼保健院行硬膜外分娩镇痛的273例产妇为研究对象，根据分娩镇痛后是否发生暴发痛分为暴发痛组（59例）和无暴发痛组（214例）。比较两组产妇人口学与基础临床特征，产程及分娩相关参数，硬膜外镇痛技术及管理参数；采用多因素一般Logistic回归模型分析硬膜外分娩镇痛后暴发痛的危险因素。结果 暴发痛组身高、血红蛋白水平、脉冲单次给药量和暴发痛组开始镇痛时宫口开大程度均低于无暴发痛组（P <0.05）；暴发痛组产次1次占比，第一产程时间，分娩前估计胎儿体重，镇痛后15、30 min数字评分量表（NRS）评分，枕后位占比均高于无暴发痛组（P <0.05）；多因素一般Logistic回归分析结果显示，血红蛋白水平低［O^R =0.891（95% CI：0.800，0.991）］、第一产程时间长［O^R =1.015（95% CI：1.004，1.027）］、脉冲单次给药量小［O^R =0.968（95% CI：0.940，0.997）］、镇痛后15 min NRS疼痛评分高［O^R =6.505（95% CI：1.040，40.698）］、分娩前估计胎儿体重大［O^R =1.017（95% CI：1.008，1.025）］是硬膜外分娩镇痛后发生暴发痛的危险因素（P <0.05）。结论 较低的血红蛋白水平、较长的第一产程时间、较小的脉冲单次给药量、较高的镇痛后15 min NRS疼痛评分及较大的分娩前估计胎儿体重是硬膜外分娩镇痛后发生暴发痛的独立危险因素。临床应针对上述因素加强监测与干预。

Abstract:

Objective To analyze the risk factors associated with breakthrough pain (BTP) after epidural labor analgesia.Methods A total of 273 parturients who received epidural labor analgesia at Meishan Maternal and Child Health Hospital from November 2025 to March 2026 were enrolled and divided into a BTP group (n = 59) and a non-BTP group (n = 214) based on the occurrence of BTP after analgesia. Demographic and baseline clinical characteristics, labor and delivery-related parameters, and epidural analgesia technique and management parameters were compared between the groups. Multivariable logistic regression was used to identify risk factors for BTP after epidural labor analgesia.Results The BTP group exhibited significantly lower height, hemoglobin level, bolus dose, and cervical dilation at the initiation of analgesia compared with the non-BTP group, while the proportion of women with a parity of 1, occiput posterior position, as well as the duration of the first stage of labor, estimated fetal birth weight, and NRS scores at 15 min and 30 min post-analgesia were significantly higher in the BTP group than in the non-BTP group (P < 0.05). Multivariable logistic regression analysis revealed that lower hemoglobin level [O^R = 0.891 (95% CI: 0.800, 0.991) ], longer duration of the first stage of labor [O^R = 1.015 (95% CI: 1.004, 1.027) ], smaller bolus dose [O^R = 0.968 (95% CI: 0.940, 0.997) ], higher NRS score at 15 min post-analgesia [O^R = 6.505 (95% CI: 1.040, 40.698) ], and larger estimated fetal birth weight [O^R = 1.017 (95% CI: 1.008, 1.025) ] were independent risk factors for BTP after labor analgesia (P < 0.05).Conclusion Lower hemoglobin level, prolonged first stage of labor, smaller bolus dose, higher NRS score at 15 min post-analgesia, and larger estimated fetal birth weight are independent risk factors for BTP after labor analgesia. Clinical monitoring and intervention should be strengthened targeting these specific factors.