产程中腰麻-硬膜外联合镇痛对母儿影响的研究  

Study on the effect of combined spinal-epidural analgesia on mother and infant during labor

作　　者：张渺[1] 杨慧霞[1] 张素萍[2] 东红 靳多香 

机构地区：[1]北京大学第一医院妇产科,100034 [2]山东省邹城市人民医院妇产科 [3]河北省华北制药医院妇产科 [4]宁夏大武口煤碳职工医院妇产科

出　　处：《中国妇幼保健》2005年第17期2161-2163,共3页Maternal and Child Health Care of China

摘　　要：目的了解产程中应用腰麻-硬膜外联合麻醉和产妇自控硬膜外镇痛(CSEA+PCEA)是否对母儿存在不良影响。方法回顾性分析627例初产妇病历资料,观察组(CSEA+PCEA)共345例,对照组(未采用CSEA+PCEA)282例,比较两组产程经过、分娩方式及母儿结局。结果镇痛后VAS疼痛评分下降(87.5±12.5)%。观察组产程中需增加催产素用量(41.4%)、出现胎心异常(36.5%)及因胎心异常手术产(26.4%)较对照组增加(对照组26.6%、20.6%、15.6%);活跃期及第二产程时间观察组延长,两组分别为271.93±127.44min、57.39±35.52min和188.08±110.29min、44.84±31.92min;观察组产钳率(18.0%)及剖宫产率(24.9%)、产程中发生尿潴留(27.0%)及羊水变化(21.4%)均较对照组增加(对照组分别为11.7%、12.1%、10.3%、14.6%),第三产程、产后出血、新生儿Apgar评分及产后尿潴留两组无差异。结论CSEA+PCEA镇痛效果满意,但对产程进展及胎儿存在一定的不良影响,并非理想的产时镇痛方法。Objective： To study whether combined spinal - epidural analgesia （ CSEA ） and patient - control epidural analgesia （PCEA） has influence on mothers and infants. Methods ： Cases data of 627 healthy nulliparas were retrospectively analyzed, study group （345 cases） accepted CSEA ＋ PCEA and control group （282 cases） without CSEA ＋ PCEA, to compare the labor course, delivery way and the maternal and fetal outcome. Results： After CSEA ＋ PCEA, the VAS score decreased 87. 5% ± 12. 5% , there were more amount of oxytocin （41.4% vs 26. 6% ）, more fetal heart rate abnormal （FHR） （36. 5% vs 20. 6% ） and more surgery delivery because of abnormal FHR （26.4% vs 15.6% ）, more urine retention during labor （27.0% and 10. 3% ） and more amnion meconium （21.4% and 14. 6% ） in the study group than those in the control group. The time of active phase of labor and second stage of study group prolonged than that of control group （271. 93± 127. 44 min and 188.08 ± 110.29 min, 57.39± 35.52 and 44.84 ± 31.92 min） .There were more forceps （ 18.0% and 11.7% ） and cesarean section （24.9% and 12.1% ） in the study group. There were no difference between two groups in the time of 3rd stage, the incidence of postpartum hemorrhage, the Apgar score of newborn and postpartum urine retention. Conclusion： CSEA ＋ PCEA has satisfied analgesic effect, but also has some adverse effects on mothers and infants, so it isnt an ideal method of obstetric anesthesia.

关 键 词：产程 镇痛 腰麻-硬膜外麻醉 

分 类 号：R719[医药卫生—妇产科学]