自控硬膜外分娩镇痛对产程和母婴预后的影响  

Influence of Patient-controlled Epidural Analgesia on Clinical Outcome of Labor

作　　者：江露[1] 李红雨[1] 曹坪[1] 冯春雨[1] 

机构地区：[1]解放军第三军医大学附属西南医院妇产科,重庆400038

出　　处：《临床军医杂志》2010年第1期98-100,共3页Clinical Journal of Medical Officers

摘　　要：目的观察罗哌卡因配伍芬太尼用于自控硬膜外分娩镇痛对产程和母儿预后的影响。方法回顾性分析在西南医院妇产科分娩的568例初产妇,其中接受0.15%罗哌卡因+芬太尼(1 mg/L)硬膜外镇痛的315例产妇为镇痛组,条件相似未行镇痛的253例产妇为对照组,记录两组的镇痛效果、活跃期时间、各产程时间、催产素使用情况、分娩方式、产后出血和新生儿Apgar评分。采用视觉模拟评分(VAS)评估宫缩时疼痛,MBS评分评估下肢运动阻滞。结果镇痛满意率达96.2%。第1产程、第3产程和总产程时间两组间无差别。镇痛组第2产程延长、阴道顺产率和阴道助产率均高于对照组,活跃期更快,催产素使用率高于对照组,新生儿窒息率无增加。结论罗哌卡因配伍芬太尼用于自控硬膜外分娩镇痛可降低剖宫产率,提高顺产率,缩短活跃期,且不增加母婴并发症,是一种安全、有效、值得推广的分娩镇痛方法。Objective To investigate the effect of patient-controlled epidural analgesia with ropivacaine in combination with fentanyl on the clinical outcome of labor. Methods A retrospective study was conducted involving 568 healthy primiparas, including 315 ones undergoing spontaneous labor who received epidural ropivacaine （0.15%） in combination with fentany （1 μg/ml） and 253 ones without epidural analgesia. The analgesic activities, active phase duration, durations of each labor stages, usage of oytocin, delivery modes, postpartum hemorrhage, and Apgar scores for neonatus were recorded in the two groups. The visual analogue scale （VAS） was used to assess the pain of uterine contraction, and modified Bromage scoring system （MBS） applied to evaluate the lower limb motor block. Results The satisfaction rate of analgesia was 96.2%. There were no significant differences in the duration of the first, the third or the total labor stages between the two groups, but the second labor stage was prolonged in the labor analgesia group. The ratio of spontaneous labor, assisted vaginal delivery and usage of oxytocin were higher, whereas the duration of the active stage was shortened, and the ratio of asphyxia neonatorum was not increased in the analgesia group. Conclusion Patient-controlled epidural ropivacaine in combination with fentanyl in labor can decrease the incidence of cesarean section, increase the ratio of spontaneous labor and shorten the duration of the active stage without increasing the complications of mother and baby. So it is a safe and effective method for labor analgesia and is worthy spreading.

关 键 词：分娩镇痛 罗哌卡因 芬太尼 分娩结局 

分 类 号：R971.2[医药卫生—药品]