不同时机实施分娩镇痛对产程及分娩方式的影响  

Effects of intrapartum analgesia at different stages on labor and mode of delivery

作　　者：李京霞[1] 刘东[1] 汤芹芹[1] 刘翔[1] 段如刚[1] 李远东[1] 

机构地区：[1]成都市第二人民医院疼痛科,成都610017

出　　处：《西南国防医药》2011年第12期1300-1303,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨在不同时机实施硬膜外分娩镇痛对产程的长短及分娩方式的影响。方法将愿意接受硬膜外分娩镇痛的足月初产妇180例随机分为两组:潜伏期组(A组,宫口<3 cm)和活跃期组(B组,宫口>3 cm)。硬膜外穿刺成功后,两组首剂给予0.125%罗哌卡因和0.5μg/ml舒芬太尼混合液10～15 ml,30 min后连接镇痛泵,背景剂量2 ml/h,追加剂量2 ml,锁定时间15 min。连续监测呼吸循环情况,采用视觉模拟疼痛评分(VAS),并观察记录产程进展及分娩方式、产后出血量、新生儿Apgar评分、缩宫素使用情况、副作用及产妇满意度。结果两组镇痛后VAS评分均降低,与B组相比,A组潜伏期VAS评分明显降低(P<0.05),器械助产率升高(P<0.05),镇痛满意度升高,下肢麻木发生率升高(P<0.05)。两组产程、剖宫产率、催产素使用量、产后出血量、新生儿Apgar评分无统计学差异(P>0.05)。结论分娩早期实施椎管内麻醉镇痛不影响产程和剖宫产率,可提高孕妇对分娩镇痛的满意度,但器械助产率有所增高。Objective To investigate the effects of intrapartum epidural analgesia at different stages on length of labor and mode of delivery.Methods 180 primiparas with termpregnancy who were willing to accept intrapartum epidural analgesia were randomly divided into two groups：latency group（group A）and active phase group（group B）.Group A underwent the analgesia before the diameter of cervical opening was larger than 3 cm.Group B received the analgesia after the diameter of cervical opening reached to 3 cm.After successful epidural puncture,both groups received 10-15 ml mixed liquor of 0.125% ropivacaine and 0.5 μg/ml of sufentanil,and 30 min later were connected to analgesia pump.The background dose was 2 ml/h,and the boost was 2 ml.The locking time was 15 min.Respiratory and circulatory conditions were continuously monitored and the pain level was evaluated by visual analogue score（VAS）.The progress of labor,mode of delivery,postpartum hemorrhage,neonatal Apgar score,the use of oxytocin,the side effects and maternal satisfaction were observed and recorded.Results The VAS in the two groups decreased after the analgesia.Compared with group B,the VAS of pain in group A decreased obviously（P0.05）.At the same time,the rate of instrumental delivery increased,the satisfaction of analgesia and the incidence of lower extremity numbness increased（P0.05,respectively）in group A.There were no significant differences in labor,rate of cesarean section,consumption of oxytocin,postpartum hemorrhage and neonatal Apgar score between the two groups（P0.05）.Conclusion The implementation of intraspinal anesthesia analgesia in the early stage of labor will not affect the labor process and the rate of cesarean section.It can increase the maternal satisfaction with intrapartum analgesia,but the rate of instrumental delivery also increases.

关 键 词：分娩镇痛 硬膜外 潜伏期 产程 分娩方式 

分 类 号：R714.3[医药卫生—妇产科学]