腰麻硬膜外联合分娩镇痛与自由体位待产的探讨  

Study on analgesia Labor with Combined Spinal and Epidural Anesthesiawang in Free Position

作　　者：赵长珍[1] 王卫东[1] 李淑艳[1] 赵国春 

机构地区：[1]山东省滨州市人民医院妇产科,滨州256610 [2]山东省滨州市妇幼保健院

出　　处：《中华当代医学》2005年第8期2-4,共3页Chinese Modern Medicine

摘　　要：目的探讨自由体位腰麻硬膜外联合镇痛（CSEA）减轻或消除产痛以及对产程、胎儿、分娩方式的影响。方法选择180例无产科、麻醉科禁忌症的初产妇分为自由体位腰麻硬膜外联合分娩镇痛组和硬膜外持续给药分娩镇痛组，每组各90例，在宫口开大2～4cm时，分别施行腰麻硬膜外联合镇痛和硬膜外镇痛，并与条件相似、不用任何镇痛措施的90例初产妇进行对照（对照组）比较三组产痛程度、运动神经阻滞，副作用，产程进展速度、分娩方式及对胎儿的影响。结果自由体位CSEA镇痛有效率较硬膜外组明显提高（P〈0．01），活跃期较对照组缩短，宫颈扩张速度加快，经阴道自然分娩率高于硬膜外组（P〈0．05）。胎儿窘迫及新生儿窒息、产后出血发生率三组比较，无显著性差异。结论自由体位CSEA应用于产科分娩，可达到镇痛要求，产程加速，不增加器械助产率。Objective To investigate the effect of combined spinal and epidural anesthesia （CSEA） in free position on relieving and eliminating the labor pain and the effect on newborns, labor process and delivery mode. Methods 270 cases without any obstetric complications and anesthetic contraindications were selected and randomly divided into three groups. CSEA and epidural analgesia was applied when cervix dilated for about 2 - 4 cm in each study group （90 cases in each） , CSEA group was predelivery in free position, another 90 labor women without any analgesia for labor as control group. To compare the labor pain, duration, delivery mode and neonate status in three groups. Results Good effects on the relief of labor pain, the active phase of labor course shortened and cervical dilation accelerate showed in CSEA group. There were no differences on the incidence of fetal distress, neonatal asphyxia and postpartum hemorrhage in three groups. CSEA group rate of instrumental delivery was lower than epidural analgesia. Conclusion Application of CSEA in free position is benefit on relieving labor pain, accelerating labor course and causes no side effect on neonates.

关 键 词：腰麻 硬膜外麻醉 体位 分娩 疼痛 

分 类 号：R614.1[医药卫生—麻醉学]