潜伏期硬膜外产时镇痛对母儿结局的影响  

Study on the effect of patient-controlled epidural analgesia in latent phase on both mothers and fetus

作　　者：张渺[1] 孙小梅[1] 陈磊[1] 耿志宇[2] 杨慧霞[1] 

机构地区：[1]北京大学第一医院妇产科,100034 [2]北京大学第一医院麻醉科,100034

出　　处：《中华围产医学杂志》2007年第1期6-9,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的了解潜伏期硬膜外镇痛是否存在对母儿的不良影响。方法回顾性分析273例初产妇病历资料，潜伏期镇痛（潜伏期组）124例，活跃期镇痛（活跃期组）共149例作为对照组。比较两组产程经过、分娩方式及结局。结果两组的年龄、妊娠次数、分娩前一周内羊水指数、分娩孕周及新生儿体重无统计学差异。需人工破膜或催产素加强宫缩、产程中排尿困难需导尿处理和产后尿潴留的比例，及镇痛后下肢麻木、产后出血、胎心异常、羊水变化、脐动脉血pH异常的发生率和Apgar评分异常的比例两组均无差异。潜伏期组中阴道顺产、产钳、剖宫产分别为71（57．3％）、20（16．1％）、33（26．6％）例，活跃期组则分别为89（59．7％）、33（22．1％）、27（18．2％）例（P=0．169）；阴道分娩者第一产程时间潜伏期组和活跃期组分别为（556．8±206．3）min和（558．5±198．4）min，（P=0．950），第二产程分别为（54．0±30．6）min和（53．1±36．4）min，（P=0．860），第三产程分别为（9．1±6．1）min，（8．1±6．5）min，（P=0．276），两组发生活跃期停滞、活跃期延长、第二产程延长和第二产程中胎位异常的比例均无统计学差异。两组产程图均位于Friedman产程图左侧，潜伏期组平均每小时宫口开大2．1cm，活跃期组每小时宫口开大1．8cm（P=0．091）。结论较活跃期镇痛比较，潜伏期镇痛未增加对母儿的不良影响；镇痛过程中的关键是注意药物浓度，镇痛起始时间应因人而异。Objective To investigate the influence of the patient-controlled epidural analgesia （PCEA） conducted in latent phase on both mothers and fetus. Methods A retrospective study was carried out on 273 healthy nulliparas in the Department of Obstetrics and Gynecology, Peking University First Hospital from Mar 2005 to Jun 2005. The subjects were divided into two groups： group Ⅰ（129 cases） received PCEA in latent phase, group Ⅱ（147 cases） received PCEA in active phase. The duration of the labor, mode of delivery and the outcomes were analyzed. Results No statistical difference was found between the two groups in maternal age, gravida, AFI within one week before delivery, gestational age and birth weight. Also, no difference was detected in the need of artificial rupture of membranes and the rate of augmentation by oxytocin, urinary retention during labor and postpartum period, numbness of lower limbs after analgesia, postpartum hemorrhage, abnormal FHR,amniotic fluid changes,abnormal pH of umbilical artery blood and abnormal Apgar score. The rate of vaginal delivery, forceps delivery and cesarean section was 71 （57.3%）, 20 （16.1%） and 33（26.6%）in gourp Ⅰ respectively and 89（59.7%）, 33（22. 1%）and 27（18. 2%）in group Ⅱ （P=0. 169）. Among those delivered vaginally, the duration of the first, second and third stage was （556.8 ±206.3）min,（54. 0±30. 6）min and （9.1±6.1）min in group Ⅰ and （558. 5±198. 4）min, （53. 1±36.4） min and （8. 1±6. 5）min in group Ⅱ （P=0. 950,0. 860 and 0. 276,respectively）. The occurrence of arrested active phase, prolonged active phase, prolonged second stage and malpresentation in the second stage was similar in both groups. The cervical dilatation curve of both groups was plotted left to the Friedman curve on the partogram. The average speed of cervical dilatation in group Ⅰ was 2.1 cm/h, and 1.8 cm/h in group Ⅱ （P=0. 091）. Conclusions PCEA in the latent phase during labor does not show more adverse effect on

关 键 词：硬膜外镇痛 产科 妊娠结局 潜伏期 分娩方式 

分 类 号：R714[医药卫生—妇产科学]