持续硬膜外阻滞分娩镇痛的子宫收缩和产程特点  

Characteristics of uterine contraction and stages of labor under continuous epidural block anesthesia

作　　者：尹春艳[1] 周敬珍[1] 吕小燕[1] 黄小鹏[1] 何桂华[1] 陈建飞[1] 

机构地区：[1]广东省第二人民医院产科,广东广州510317

出　　处：《南方医科大学学报》2006年第11期1563-1567,共5页Journal of Southern Medical University

基　　金：广东省自然科学基金(040005053)

摘　　要：目的探讨持续硬膜外阻滞分娩镇痛(以下简称分娩镇痛)的子宫收缩(以下简称宫缩)和产程特点,为分娩镇痛产程观察与处理提供临床依据。方法(1)自然临产宫口开大3cm实施分娩镇痛的产妇213例,由专人在分娩镇痛前和镇痛显效后30、60、120min时,应用美国惠普公司M1351A型胎儿监护仪,分别监测宫缩周期、持续时间、强度、宫缩曲线类型,研究分娩镇痛的宫缩特点。(2)比较分娩镇痛421例与非分娩镇痛237例产妇第1产程活跃期、第2和第3产程时间的差异,研究分娩镇痛的产程特点。结果(1)镇痛前与镇痛显效后不同时间段宫缩各项客观指标与镇痛前比较差异有显著性(P<0.05),提示镇痛后宫缩减弱有统计学意义;(2)镇痛后不同时间段宫缩各项客观指标比较差异无显著性(P>0.05);(3)镇痛组平均第1产程活跃期短于对照组(P<0.05),严密监测下合理使用催产素,平均第2、3产程时间差异无显著性(P>0.05);(4)分娩镇痛组产钳助产率高于对照组(P<0.05)。结论分娩镇痛对宫缩和产程有一定的影响,正确认识分娩镇痛的宫缩和产程特点、进行积极有效的产程处理是分娩镇痛成功的关键。Objective To observe the characteristics of uterine contraction and stages of labor during delivery under continuous epidural block anesthesia. Methods Totaling 213 parturients in spontaneous labor under epidural block anesthesia with dilated cervical orifice of 3 cm were monitored for the contraction cycle, duration, intensity and curve types of uterine contraction, and recordings were made for 30 rain before and 30, 60 and 120 rain after the anesthesia took effect, respectively. The duration of the active phase in the first, second and third stages of labor was compared between 421 cases with anesthesia and 237 without anesthesia. Results Significant difference was noted in the objective indexes of uterine contraction recorded after anesthesia had taken effect （P〈0.05） in comparison with those before anesthesia, suggesting significantly attenuated uterine contraction after anesthesia, whereas these indexes underwent no significant further variation as compared between different time points after anesthesia （P〉0.05）. The average active phase in the first stage was significantly shorter in anesthesia group than that in the control group （P〈0.05）, but the average duration of the second and third stages of labor differed little between the two groups with appropriate use ofoxytocin under strict monitoring （P〉0.05）. The rates of obstetric forceps utilization and use ofoxytocin were higher in anesthesia group than in the control group （P〈0.05）. Conclusion Epidural block anesthesia produces certain influences on uterine contraction and stages of labor during delivery, for which appropriate treatment measures may prove beneficial.

关 键 词：硬膜外阻滞麻醉 分娩镇痛 子宫收缩 产程时间 

分 类 号：R714.3[医药卫生—妇产科学]