蛛网膜下腔联合硬膜外腔阻滞用于分娩镇痛时机的探讨  

Occasion of Administration of Combined Spinal Epidural Analgesia and Patient-control Epidural Analgesia on Labor——Latent Stage Analgesia versus Active Stage Analgesia

作　　者：范建辉[1] 滕奔琦[1] 李萍[1] 李晓芸[2] 朱娟[1] 

机构地区：[1]中山大学附属第三医院妇产科,广东广州510630 [2]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2011年第5期628-632,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(10151008901000127)

摘　　要：【目的】探讨实施蛛网膜下腔阻滞-硬膜外联合分娩镇痛时机对产程和分娩结局的影响。【方法】370例产妇按照宫颈口开张程度分为2组,潜伏期组130例在宫颈口开张1～2 cm时开始实施蛛网膜下腔阻滞-硬膜外联合镇痛,活跃期组240例在宫颈口开张3～8 cm时开始实施镇痛,记录2组产妇年龄、孕周、孕次、产程、分娩方式、缩宫素应用情况、产后24 h出血量、胎儿窘迫、羊水粪染、新生儿体质量及新生儿生物物理评分(即1 min及5 min Apgar评分)、新生儿黄疸。【结果】潜伏期组和活跃期组比较,潜伏期延长[(453±203)min vs,(338±182)min,P=0.000]。活跃期组的活跃期时间明显延长[(229±109)min vs(197±101)min,P=0.011]。第2、3产程和总产程比较差异无统计学意义(P=0.200,P=0.222,P=0.091)。潜伏期组的缩宫素使用率较高(43.08%vs 23.33%,P=0.012)。两组器械助产率、剖宫产率、产后24 h出血量比较差异无统计学意义(P>0.05)。胎儿窘迫率、新生儿生物物理评分、新生儿高胆红素血症发生率2组比较差异无统计学意义(P>0.05)。【结论】潜伏期实施联合分娩镇痛可能抑制子宫收缩、延长潜伏期,正确使用缩宫素可以减少分娩镇痛带来的不利影响。【Objective】This study was designed to explore whether combined spinal-epidural analgesia（CSEA） and patient-control epidural analgesia（PCEA） has influence on labor progress and adverse events between latent stage analgesia and active stage analgesia.【Methods】 The subjects were divided into two groups： latent stage analgesia group（130 cases） received CSEA＋PCEA in latent phase（cervical dilatation was 3 cm）,active stage analgesia group（240 cases） received CSEA＋PCEA in active phase（cervical dilatation was ≥3 cm）.The following indexes were observed： age,gestational weeks,times of pregnancy,duration of labor,mode of delivery,the oxytocin infusion,the quantity of hemorrhage,fetal distress and meconium-stained amniotic fluid,fetal birth weight and Apgar scores（1,5 minutes） and neonatal jaundice.【Results】 The duration of latent phase in the latent stage analgesia group were significantly longer than that of active stage analgesia group [（453 ± 203） min vs（338 ± 182） min,P = 0.000].The duration of active phase in the active stage analgesia group were significantly longer than that of latent stage analgesia group [（229 ± 109） min vs（197 ± 101） min,P = 0.011].No statistical difference was found between the two groups in the duration of the second stage,the third stage,and total stage（P = 0.200,P = 0.222,P = 0.091,respectively）.Oxytocin application were more frequent in the latent stage analgesia group.There was no difference in the rate of instrumental delivery or cesarean section between the two groups.There was no difference in the quantity of postpartum hemorrhage between the two groups（P 0.05）.There were no significant differences in the rate of fetal distress or neonatal Apgar scorces and neonatal jaundice between the two groups（P 0.05）.【Conclusions】 CSEA ＋ PCEA in the latent phase was associated with an increased risk of inhibition of uterine contraction and prolonged latent stage.Application of oxytocin could avoid adverse effect of

关 键 词：蛛网膜下腔阻滞-硬膜外联合麻醉 潜伏期 分娩 

分 类 号：R714.3[医药卫生—妇产科学]