分娩全程硬膜外镇痛术对子宫收缩和产程的影响  

The effects of whole range epidural analgesia on the uterine contractions and birth process of nulliparous parturients

作　　者：谢淑兰[1] 欧阳葆怡[1] 陈德坚[1] 

机构地区：[1]广州医学院第一附属医院麻醉科,广东广州510120

出　　处：《中国医药导报》2010年第26期23-25,共3页China Medical Herald

基　　金：广东省科技厅项目(编号:2005B36001020)

摘　　要：目的:探讨分娩全程硬膜外镇痛对产程、子宫收缩和母婴安全的影响,评估分娩全程硬膜外镇痛的安全性和可行性。方法:要求行分娩镇痛的初产妇37例,产妇按实施分娩镇痛时宫颈扩张的程度分为活跃期镇痛组(18例)和全程镇痛组(19例),采用连续性硬膜外镇痛,全程镇痛组潜伏期使用舒芬太尼0.5μg/ml恒速输注,两组产妇活跃期均使用0.1%罗哌卡因与舒芬太尼0.5μg/ml的混合液作为镇痛药液,全程镇痛组镇痛延续至分娩后24h。观察两组疼痛评分、子宫收缩变化规律,记录分娩过程及产后24h使用缩宫药物总用量,第二、三产程和分娩方式,新生儿出生后1min及5min的Apgar评分,产后出血量。结果:两组的VAS评分、第二、三产程时间、缩宫素使用量、产后出血量、新生儿1min及5min时Apgar评分差异均无统计学意义(P>0.05)。两组共5例行剖宫产,将其纳入剖宫产组。全程镇痛组与剖宫产组在实施镇痛后30min时宫缩强度降低(P<0.01),但前者在镇痛2h后恢复至与镇痛前相近,而后者比其他两组宫缩强度低(P<0.01)。与其余两组相比,剖宫产组宫缩间隔时间与持续时间未随产程进展而改善(P<0.05)。结论:分娩全程硬膜外镇痛可使产妇获得更舒适的分娩过程,对子宫收缩及第二、三产程无明显影响,对新生儿及产妇均安全。Objective：To evaluate the safety and feasibility of whole range epidural analgesia for labor and discuss the effects of this technique on the uterine contractions,birth process and maternal and neonatal safety during all the stages of labor.Methods：Thirty-seven full-term nulliparous parturients with a single fetus and a vertex presentation were allocated into active phase analgesia group（n=18） and whole range analgesia group（n=19） according to cervix dilation and received continuous epidural analgesia.The former received Sufentanil 0.5 μg/ml till the first stage developed into active phase,then,at active phase,both groups received a mixture of 0.1% Ropivacaine and Sufentanil 0.5 μg/ml,and in whole range analgesia group,the analgesia lasted until 24 hours after labor.Visual analog scale（VAS）,pressure of uterine cavity,inter val and persistence time of uterine contractions,fetal heart rate,total dose of oxytocin,time length of the second or third stage,mode of delivery,neonate＇s 1-minute and 5-minute Apgar scores,postpartum blood loss were recorded.Results：There was no significant difference between the two groups in VAS,time length of the second or third stage,total dose of oxytocin,postpartum blood loss and neonate＇s 1-minute and 5-minute Apgar scores（P0.05）.There were 5 parturients in the two groups received cesarean section due to abnormal fetal heart rate and were re-allocated into cesarean group.The intensity of uterine contraction in whole range analgesia group and cesarean group were significantly decreased at 30 min after analgesia initiation（P0.01）.However,at 2 hours after analgesia initiation,it recovered to similar level of pre-analgesia in the former,while the latter showed a relatively low intensity of uterine contraction when compared with the other two groups（P0.01）.Compared with those in the other two groups,the time interval and time length of uterine contraction in cesarean group failed to improved along with labor proceeding（P 0.05）.Conclusion：Whole rang

关 键 词：分娩 全程 硬膜外镇痛 子宫收缩 产程 

分 类 号：R714.3[医药卫生—妇产科学]