腰-硬联合麻醉用于分娩镇痛对产妇及脐血血气影响的研究  

A study on combined spinal-epidural anesthesia,labor analgesia and the effects on pureperas and umbilical cord blood gas

作　　者：滕平[1] 修霞[1] 王增梅[1] 张成元[1] 陶华娟[1] 郭永[1] 

机构地区：[1]山东省潍坊市妇幼保健院,261011

出　　处：《中国实用医药》2008年第16期43-45,共3页China Practical Medicine

摘　　要：目的观察布比卡因复合芬太尼用于腰-硬联合麻醉分娩镇痛的效果,以及对产程和母婴的影响。方法随机选取自愿要求无痛分娩的产妇60例,使用布比卡因加芬太尼进行腰-硬联合麻醉分娩镇痛作为观察组,同期未使用任何分娩镇痛而自然分娩的产妇60例作为对照组。观察两组产妇分娩镇痛的效果、各产程的时间、分娩过程中催产素使用情况、产后2h失血量、产妇桡动脉血和新生儿脐静脉血血气分析及新生儿Apgar评分。结果①分娩镇痛药起效后产妇疼痛明显减轻,宫缩时仅感腹部发紧发胀,双下肢无麻木感,活动自如,有效率达100%,两组比较差异有统计学意义(P<0.01);②两组产妇第一产程活跃期时间缩短,两组比较差异有统计学意义(P<0.01),第二、三产程两组比较差异无统计学意义(P>0.05);③分娩过程中催产素使用情况及产后2h失血量两组比较差异无统计学意义(P>0.05);④产妇桡动脉血、新生儿脐静脉血血气分析,在分娩即刻两组母体动脉血pH、PCO2均有显著差异,新生儿脐静脉血pH、PCO2、PO2亦有显著差异,两组产妇新生儿出生后1～5minApgar评分均在8分以上,两组比较差异无统计学意义(P>0.05)。结论布比卡因复合芬太尼用于腰-硬联合麻醉分娩镇痛效果安全可靠,缩短了产程,对母亲和胎儿均无不良影响。Objective To investigate the pain-relieving effects of combined spinal-epidural anesthesia with bupivacaine and fentanyl,and its impacts on birth process, maternal and child. Methods 60 parturients that requested labor analgesia were randomly selected by combined spinal-epidural anesthesia with bupivavaine and fentanyl as the observation group. Meanwhile another 60 parturients were selected as the control group without any analgetic measuremens. The analgetic effects,stage of labor, the blood lost during the first 2 hours after delivery,the application of mesotocin during the delivery course,blood gas analysis of parturient arteria radialis and the newborn umbilical venous blood,and the Apgar score of the infants were observed respectively. Results ①The analgetic effect is better than the control group. The difference between 2 groups is very significant（ P 〈 0.01 ）. Puerperas only feel the abdomen tight and expanding. Both lower extremities. Can move flexibly without numbness. The efficiency is 100%. ②The active phase of the first stage in observation group is greatly shortened. The comparison between two groups is significant（ P 〈 0.01 ）. The difference between the second and third stage was not significant（P 〉 0. 05）. ③The blood lost during the first 2 hours after delivery and the application of mesotocin in two groups had no difference. ④There is significant difference in blood gas analysis both parturient arteria radialis blood and the newborn umbilical venous blood in pH, PCO2 and PO2. The Apgar score after birth 1-5 minutes of the newborns were above eight, and there is no difference in 2 groups （P 〉 0. 05 ）. Conclusion Combined spinal-epidural anesthesia with bupivacaine and fentanyl is safe and effective in labor analgesia. It can shorten the labor process and have no impact on puerperas and feonates.

关 键 词：布比卡因 芬太尼 腰-硬联合麻醉 分娩镇痛 

分 类 号：R714.3[医药卫生—妇产科学]