50例腰麻—硬膜外联合阻滞麻醉分娩镇痛的临床分析  

Clinical Analysis Of 50 combined spinal-epidural labor analgesia

作　　者：黄峥[1] 韩田骏[1] 李芳[1] 李玉芳[1] 

机构地区：[1]广东省广州市妇婴医院妇产科,广东广州510180

出　　处：《海南医学》2005年第12期28-29,共2页Hainan Medical Journal

摘　　要：目的探讨腰麻—硬膜外联合阻滞麻醉分娩镇痛(combinedspinal-epidurallaboranalgesiaCSEA)的效果和安全性,及其对分娩结局的影响。方法随机选取50例单胎足月头位,无麻醉禁忌症及产科并发症的初产妇为研究组,于宫口扩张3～5cm时行蛛网膜下腔穿刺术注入舒芬太尼4～10μg,继而在硬膜外腔留置一导管,持续硬膜外腔注入0.1%布比卡因+2μg/ml舒芬太尼,7ml/小时。随机选择同期条件相同,已临产,无镇痛的初产妇63例作对照组。观察两组产妇疼痛情况、产程、分娩方式、失血量、新生儿Apgar评分及母儿副作用。结果研究组镇痛有效率达90%,各产程均较对照组无明显差异,但活跃期较对照组显著延长(P<0.05)。两组产妇分娩方式、产后出血量、新生儿Apgar评分无显著差异。CSEA对母儿副作用轻微。结论CSEA是快速、可靠、安全的分娩镇痛方法,它延长活跃期,但不延长各产程,不影响分娩方式及产后出血量,值得大力推广。Objective To evaluate the pain relief effectiveness and safety of combined spinal-epidural labor analgesia（CSEA） and it＇s influences on the outcome of labor. Methods 50 uncomplicated nulliparas with term, singleton fetus in cephalic presentation who requested analgesia without any medical contraindications were taken randomly for the observe group, in the meantime 63 parturienks under the same condition without anesthetic intervention were taken randomly for the control group. At a cervical dilatation of 3-5cm, the observe group was injected 4-10ug of sufantanil directly into CSF with CSEA technique and a catheter is placed into the epidural space, then an infusion of sufantanil 2μg/ml with a small amount of bupivacaine 0.1% （at the rate of 7ml/hour） was initiated through the catheter. The degree of pain, duration of labor, methods of delivery, bleeding volume, neonatal APGAR Score as well as maternal and fetal/neonatal side effects were observed. Restilts The pain relief effectiveness amounted to 90% in the observe group. There were no significant differences between both groups in the duration of each stage of labor, however, the duration of active labor in the observe group was significantly prolonged（P〈0.05） as compared to the control group. No significant differences were found hetween both groups in the methods of delivery, bleeding volume and neonatal APGAR Score. The maternal and fetal/neonatal side effects were mild. Conclusions CSEA is a rapid, reliable and safe technique that prolongs the duration of active labor without significant influence on that of each stage of labor, methods of delivery and bleeding volume. CSEA should be strongly recommended to all laboring parturients who do not have any medical contradiction to this method of treatment.

关 键 词：分娩镇痛 腰麻-硬膜外联合阻滞麻醉 硬膜外阻滞麻醉 

分 类 号：R614[医药卫生—麻醉学]