产程潜伏期腰-硬联合阻滞分娩镇痛的可行性研究  

Feasibility of Combined Spinal-epidural Analgesia During Latent Phase of Labor

作　　者：王琳[1] 田鸣[2] 徐铭军[1] 

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,北京市100026 [2]首都医科大学附属北京友谊医院麻醉科

出　　处：《中国全科医学》2010年第6期593-596,共4页Chinese General Practice

基　　金：首都医学发展科研基金(C03030301)

摘　　要：目的评估潜伏期腰-硬联合阻滞分娩镇痛对自然分娩的临床效果及对产程、分娩结局和母婴的影响。方法将无病理产科因素及椎管内麻醉禁忌证,美国标准协会(ASA)Ⅰ～Ⅱ级的足月初产妇60例,随机分为两组(n=30):潜伏期组(L组)于宫口开大0.5～2.5cm时行分娩镇痛,活跃期组(A组)于宫口开大3.0～5.0cm时行分娩镇痛。两组操作过程完全一致,孕妇取左侧卧位,采用联合腰麻及硬膜外穿刺包于L2～3间隙行硬膜外腔穿刺,成功后取25G腰麻穿刺针置入硬膜外穿刺针内,刺入蛛网膜下腔,于子宫收缩间期注入0.1%罗哌卡因3ml(3mg),置入硬膜外导管,接自控电子镇痛泵。待腰麻作用减弱时,采用自控硬膜外镇痛(PCEA)的给药模式产妇自控镇痛,APⅡ电子泵内配置为0.1%罗哌卡因及0.5μg/ml舒芬尼混合液,总量100ml;设置单次剂量为5ml,锁定时间10min。宫口开全时停止PCA泵。记录视觉模拟疼痛评分(VAS),记录镇痛前及镇痛后直至宫口开全时8个点的疼痛评分;产程潜伏期、活跃期、第二产程、第三产程持续时间及缩宫素使用情况;分娩结局、产时出血量;记录镇痛药物使用情况;镇痛不良反应;产妇满意度及新生儿情况。结果两组产妇年龄、身高、体质量组间差异无统计学意义(P>0.05)。镇痛前的VAS评分活跃期组M=100分(80分,100分)与潜伏期组M=90分(80分,100分)间差异有统计学意义(P<0.05),行分娩镇痛后VAS评分、产程各阶段持续时间、分娩方式、产时出血量、缩宫素使用率、不良反应发生率、新生儿Apgar评分、胎儿宫内窘迫发生率组间差异均无统计学意义(P>0.05),镇痛药用量潜伏期组[(23.9±8.9)ml]较活跃期组[(17.6±9.6)ml]明显增多(P<0.05),缩宫素使用时间潜伏期组为(228±139)min,较活跃期组(152±103)min长(P<0.05),潜伏期组产妇满意度较高(P<0.05)。结论鞘内注入0.1%罗哌卡因,而后连接自控电子泵(0.1%罗哌卡因及0.5μg/ml舒芬�Objective To evaluate the efficacy, as well as influence to stage of labor, delivery and mother- infant of the combined spinal - epidural analgesia in primiparas presenting in latent phase of spontaneous labor. Methods Sixty primiparas, who had no pathological factor of obstetrics, no counter - indication of intravertebral anesthesia, and whose physical status grade I or II of ASA, were randomly divided into two groups, with 30 in each. The primiparas were given labor analgesia as their cervical dilation was 0. 5 - 2. 5cm in the latent group （ L group）, and 3.0 - 5.0 cm in the active group （ A group. The pri- miparas took left lateral position ; the epidural puncture was performed at L2 - L3 interspace, then a 25 G needle for lumber anesthesia was installed into epidural puncture needle which went into subarachnoid cavity. Some 3mL （3 mg） of 0. 1% Ropivacaine was given during the period of uterine contraction, the epidural catheter was connected with a AP II patient - controlled analgesia （PCA） pump. As the lumber anesthesia become weaker, the administrative mode by PCEA was used for anesthesia. A 100 mL mixture of 0. 1% Ropivacaine with 0. 5μg/ml Sufentanil was put into the APII pump; a single dose was 5 ml, and the lockout interval was 10 minutes. The pump was stopped when the cervical orifice was opening fully. Visual analogue scale （VAS） was used to record pain scores before aesthesia and at 8 time points after anesthesia. The lasting times of latent stage of labor, active stage, the second stage, and the third stage; as well as usage of pitocin, delivery outcome, volume of bleeding, analgesic usage, side effects of analgesia, degree of satisfaction of the primipara, and neonate condition were all recorded. Resuits There was no significant difference between the two groups in age, height, and body weight （ P 〉 0. 05 ）. There was a significant difference in VAS score between active stoup [ M = 100 （80. 100）] and latent group [ M = 90 （80, 100）] before labor analgesia （P 〈 0

关 键 词：潜伏期 分娩镇痛 腰-硬联合阻滞 可行性 

分 类 号：R614.42[医药卫生—麻醉学]