蛛网膜下腔-硬膜外联合阻滞麻醉对产程进展、母儿预后及分娩方式的影响  

Effect of spinal-epidural anesthesia on the labor course and delivery outcomes

作　　者：李荣环 周尚菲 杨大同[2] 张昊 

机构地区：[1]北京市隆福医院妇产科,北京100010 [2]北京市朝阳区妇幼保健院,北京100026

出　　处：《生殖医学杂志》2009年第2期123-126,共4页Journal of Reproductive Medicine

摘　　要：目的探讨蛛网膜下腔阻滞(腰麻)联合硬膜外阻滞麻醉对产程进展、分娩方式及母儿合并症的影响。方法回顾分析2006年1月至2007年12月分娩的2,526例产妇,分为腰麻加硬膜外阻滞(联合麻醉组)1,006例和未施行分娩镇痛(对照组)1,520例,比较两组产妇在产程进展、分娩方式、母儿合并症方面的差异。结果 (1)第一产程活跃期、第二产程及第三产程时间:联合麻醉组分别为(271±127)、(57±35)和(8.9±6)min;对照组分别为(187±110)、(45±31)和(9.0±6)min。第一产程活跃期及第二产程时间联合麻醉组均显著长于对照组(P<0.01),第三产程两组比较差异无统计学意义(P>0.05)。(2)分娩方式比较:①剖宫产联合麻醉组为301例(29.92%),对照组为700例(46.05%),两组比较差异有统计学意义(P<0.01)。②产钳助产分别为157例(15.61%)及134例(8.82%),两组比较差异有统计学意义(P<0.01);③阴道顺产分别为548例(54.47%)及686例(45.13%),两组比较差异有统计学意义(P<0.01)。(3)母儿合并症:胎儿窘迫、新生儿窒息及产后出血的发生率,联合麻醉组分别为339例(33.70%)、10例(0.99%)及41例(4.08%);对照组分别为433例(28.49%)、19例(1.25%)及60例(3.95%);胎儿窘迫发生率两组比较有统计学差异,而新生儿窒息和产后出血发生率两组比较无统计学差异。结论产程中对产妇实施腰麻加硬膜外阻滞镇痛,可降低剖宫产率,但增加产钳助产率;分娩镇痛与活跃期阻滞、活跃期延长及第二产程延长有关,但不增加产后出血及新生儿窒息的发生率。Objective：To evaluate the effect of spinal-epidural anesthesia as a pain relief during labor on the duration of labor stages and delivery outcomes. Methods：A total of 2,526 deliveries in our hospital from Feb. 2006 to Dec. 2007 were studied retrospectively. 1,006 pregnant women were treated with spinal-epidural anesthesia （combined epidural group） during the labor and 1,520 without any pain relief during labor were as control. The duration of labor, delivery method and maternal, fetal complications among two groups were compared. Results： （1） In the combined epidural group, the duration of active phase in the first stage （271± 127 min） and the duration of the second stage （57 ± 35 min） were significantly longer than those in control group （187±110 rain and 45±31 min, respectively）. No significant difference in the duration of the third stage was found between the two groups （8.9±6 rain in combined epidural group vs. 9.0±6 rain in control group, P〉0.05） ; （2） The delivery methods employed were significantly different （P〈0.01） between two groups. The cesarean section （CS） rate was 29.92% （301/1,006） in the combined epidural group, and 46.05% （700/1,520） in control group. The rate of forceps delivery was 15. 61% and 8. 82% in combined epidural group and control group, respectively. The rate of normal delivery was also significantly different between two groups （54.47% in combined epidural group vs. 45.13% in control group） （P〈 0.01） ; （3） The rate of fetal distress in combined epidural group （33.70%） was higher than that of control （28.49%） （P〈0.01）, while no difference （P〉0. 05） in postpartum hemorrhage and neonatal asphyxia was found between combined epidural group （4.08% and 0.99%, respectively） and control （3.95% and 1.25%, respectively）. Conclusions：Anesthetic relief during the labor may reduce the CS rate, but increase the rate of forceps delivery. Pain relief was associated with the arrested and prolong

关 键 词：产科 镇痛 联合麻醉 分娩方式 

分 类 号：R714.3[医药卫生—妇产科学] R713.42[医药卫生—临床医学]