腰-硬联合阻滞复合笑气吸入用于分娩镇痛的临床研究  

Clinical study of spinal and epidural block combined with nitrous oxide inhalation for labor analgesia

作　　者：龚辉 姜娜 卢江明 闫建军 

机构地区：[1]陕西省妇幼保健医院麻醉科,陕西西安710003

出　　处：《现代生物医学进展》2010年第12期2276-2278,共3页Progress in Modern Biomedicine

基　　金：陕西省卫生厅科研基金(08B05)

摘　　要：目的:探讨腰-硬联合阻滞复合笑气吸入用于分娩镇痛中的镇痛效果以及对产妇和新生儿的影响。方法:选择ASAI-II级,自愿接受分娩镇痛的产妇600例,随机分为3组,每组200例。Ⅰ组:腰-硬联合麻醉,罗哌卡因芬太尼混合液产妇自控硬膜外镇痛;Ⅱ组:笑气吸入分娩镇痛;Ⅲ组:腰-硬联合麻醉,罗哌卡因芬太尼混合液产妇自控硬膜外镇痛复合笑气吸入分娩镇痛。分别观察三组产妇的镇痛效果、产程时间、产妇血氧饱和度、分娩方式及新生儿的窒息情况。结果:三组产妇的年龄、体重和孕周等比较,差异无显著意义(p>0.10);产程时间比较:第一产程活跃期、第二产程,Ⅲ组时间与Ⅱ组无明显差异,但均较Ⅰ组短,差异有统计学意义(p<0.05);镇痛效果比较:Ⅲ组与Ⅰ组无明显差异,但均较Ⅱ组好,差异有统计学意义(p<0.05);新生儿窒息情况比较:Ⅲ组与Ⅱ组1分钟的Apgar评分均大于Ⅰ组(P<0.05),5分钟Apgar评分三组间差别无统计学意义(p>0.05);三组产妇的血氧饱和度及剖宫产率比较均无统计学意义(p>0.05)。结论:腰-硬联合麻醉及产妇自控硬膜外镇痛复合笑气吸入分娩镇痛方式明显优于单纯的腰-硬联合麻醉及产妇自控硬膜外镇痛方式或笑气吸入分娩镇痛方式,其镇痛效果良好,对产程及新生儿Apgar评分影响小,是分娩镇痛的理想选择。Objective To study the pain relief in delivery and the influence on maternal and infants by using spinal and epidural block combined with nitrous oxide inhalation for labor analgesia.Methods：Six hundred ASA I-II maternal which voluntarily accept labor analgesia were randomly divided into three groups,each with two hundred cases.GROUP Ⅰ：Labor analgesia by spinal-epidural block and patient controlled epidural analgesia using ropivacaine mixed with fentanyl.GROUP Ⅱ：Labor analgesia by nitrous oxide inhalation.GROUP Ⅲ：Labor analgesia by spinal-epidural block and patient controlled epidural analgesia using ropivacaine mixed with fentanyl combined with nitrous oxide inhalation.Observed the analgesia score,duration of labor,blood oxygen saturation of maternal,way of delivery and neonatal asphyxia of each case during labor analgesia.Results：Comparing GROUP Ⅲ with GROUP Ⅰ or GROUP Ⅱ,there was no statistically difference between the patients＇age,weight、and gestational age（p 0.10）;the time of the first active phase of labor and the second stage was significant difference（p0.05）,the time of GROUP Ⅲ was shorter than that of GROUP Ⅰ;the difference of analgesic effect was statistically significant（p0.05）,analgesia of GROUP Ⅲ was better than that of GROUP Ⅱ;the difference of neonatal Apgar score in 1 minute was statistically significant（p0.05）,the Apgar score of GROUP Ⅲ was bigger than that of GROUP Ⅰ,but the difference of neonatal Apgar score in 5 minutes was not statistically significant（p0.05）;and there was no significant difference between the patients＇blood oxygen saturation and the way of delivery.Conclusions：The labor analgesia by spinal epidural block and patient controlled epidural analgesia using ropivacaine mixed with fentanyl combined with nitrous oxide inhalation was obviously better than that only by spinal-epidural block and patient controlled epidural analgesia using ropivacaine mixed with fentanyl or by nitrous oxide inhalation.It＇s the optimal ideal

关 键 词：分娩镇痛 腰-硬联合阻滞 氧化亚氮 

分 类 号：R614[医药卫生—麻醉学]