三种分娩镇痛方式的效果比较  

Clinical Study on Painless Labor at Three Different Ways

作　　者：高鲜花[1] 

机构地区：[1]西安市红十字会医院妇产科,710054

出　　处：《美中国际创伤杂志》2012年第3期12-14,共3页U.S.Chinese International Journal of Traumatology

摘　　要：目的：比较自控硬膜外阻滞麻醉、自控静脉麻醉和笑气吸入三种方法的分娩镇痛效果和对产妇及新生儿的影响。方法：随机选取200例产妇为笑气组、自控硬膜外阻滞组、自控静脉麻醉组和对照组，每组各50例。在分娩过程中，笑气组给予吸入含50％笑气与50％氧气的混合气体，自控硬膜外阻滞组联合注入罗哌卡因和芬太尼、自控静脉麻醉静脉注射瑞芬太尼，对照组未给予镇痛药物。分别观察4组产妇的镇痛效果、产程时间、分娩方式、产后出血量、胎儿窘迫及新生儿窒息情况。结果：①镇痛效果比较：自控硬膜外阻滞镇痛分级0级42例，自控静脉麻醉组43例，笑气组6例，对照组0例（1级：阻滞组7例，静脉组6例，笑气组39例，对照组0例）。4组比较，差异有极显著性（P〈0．01）；②产程时间比较：镇痛3组的产程均较对照组缩短，有显著差异性（P〈0．05）；③4组产妇分娩方式、产后出血量、胎儿宫内窘迫及新生儿窒息发生率比较：差异无显著性（P〉0．05）。结论：自控硬膜外阻滞麻醉、自控静脉麻醉用于分娩有确切的镇痛效果，对产妇及新生儿无明显副作用，可在有一定医疗条件的医疗单位应用；笑气吸入用于分娩，有较好镇痛效果，且方法简单，对产妇及新生儿无明显的副作用，值得推广使用，尤其适用于基层单位。Objective： To compare the analgesic effects of patient-controlled epidural anesthesia （PCEA）, pa- tient-controlled intravenous anesthesia （PCIA） and inhalation of nitrous oxide （N2O） during indolence delivery, and to observe its influences on mothers and infants. Methods： 200 pregnant women were randomly divided into 4 groups： N2O group, PCEA group, PCIA group and control group. During the delivery period, 50% N2O premixed with 50% oxygen was given to the pregnant women in N2O group, ropivacaine and fentanyl was given to PCEA group, remifentanil was given to PCIA group and nothing was given to the control group. Then the analgesic effect, labor time, modus of delivery, volume of postpartum hemorrhage, fetal distress and neonatal asphyxia in 4 groups were observed. Results： （1）Analgesic effect was classified as grade 0 in 42 cases of PCEA group, 43 cases of PCIA group, 6 cases of N2O group and 0 in control group, and was clas- sifted as grade 1 in 7 cases of PCEA group, 6 cases of PCIA group, 39 cases of N2O group and 0 in con- trol group. No significant difference was noted in 4 groups （P〈0.01）; （2）Time of birth process in 3 analgesic groups was shorter than in control group, there was a significant difference （P〈0.05）; （3）There was not a sig- nificant difference in modus of delivery, volume of postpartum hemorrhage, incidence rate of fetal distress and neonatal asphyxia among the 4 groups （P〉0.05）. Conclusion： PCEA and PCIA for childbirth can get an exact analgesic effect and has rarely side effect for the mothers and infants. It can be used in the medical therapy unit with a sure medical condition. N2O inhalation for childbirth also can get a good effect and worth to use, especially in the basic units.

关 键 词：无痛分娩 自控硬膜外麻醉 氧化亚氮 自控静脉麻醉 

分 类 号：R714[医药卫生—妇产科学]