硬膜外镇痛分娩对产程及胎儿血气的影响  

The influence of epidural analgesia in delivery on labor stage and fetal blood gas status

作　　者：宋丽[1] 张英[2] 周述芝[1] 冯光连[3] 

机构地区：[1]泸州医学院附属医院麻醉科,四川泸州646000 [2]泸州医学院附属中医院麻醉科,四川泸州646000 [3]泸州医学院附属医院妇产科,四川泸州646000

出　　处：《实用医院临床杂志》2014年第6期110-112,共3页Practical Journal of Clinical Medicine

摘　　要：目的观察硬膜外镇痛分娩对产程及胎儿血气的影响,评价其安全性。方法观察组为临产后自愿要求硬膜外镇痛分娩的初产妇60例,对照组为随机抽取的同期未用任何镇痛方法分娩的初产妇60例。观察两组镇痛效果、产程各阶段时间、催产素使用情况、分娩方式、胎儿脐动静脉血气分析和新生儿第1、5 min时点的Apgar评分。结果随着产程进展,对照组产痛明显增加,而观察组在实施硬膜外镇痛后产痛明显降低,差异有显著统计学意义(P<0.001)。与对照组比较,观察组实施镇痛后VAS评分降低,第二产程时间延长,催产素使用率和使用量升高,差异均有统计学意义(P<0.05);两组间脐动、静脉血p H、Pa O2、Pa CO2、BE值以及新生儿Apgar评分差异均无统计学意义(P>0.05)。结论配合催产素的使用,硬膜外镇痛分娩对第一产程时间无明显影响,虽会延长第二产程时间,但对产妇最终的分娩方式、胎儿血气和新生儿Apgar评分无不良影响,对母儿安全。Objective To evaluate the safety of epidural analgesia in delivery to mother and fetus. Methods Sixty puerpera who choose the epidural analgesia in delivery were assigned as observation group while another 60 puerpera without epidural analgesia were assigned as control group. The analgesic effect, time of every labor stage, use of oxytocin, mode of delivery and fetal blood gas status of umbilical artery and vein, as well as Apgar score at the first and fifth minute were compared between the two groups. Results Along with the process of labor, the control group had increased labor pains while the observation group had decreased labor pains after epi- dural analgesia. The difference was statistically different （P 〈 0. 001 ）. Compare to the control group, VAS score in the observation group was significantly decreased, the longer second-stage of labor was prolonged and use rate and dose of oxytocin were increased （P 〈 0. 05 ）. There have no statistically significant changes in pH, PO2, PCO2and BE of umbilical artery and vein as well as newborn Apgar score between the two groups. Conclusion With oxytocin, epidural analgesia in delivery has no obvious effect on the first-stage of la- bor. Although it can prolong the second-stage of labor, it has no adverse effects on the final mode of delivery, fetal blood gas and neo- nates Apgar score. Therefore, it is safe for mother and fetus.

关 键 词：硬膜外镇痛分娩 产程 胎儿血气 新生儿Apgar评分 

分 类 号：R614.42[医药卫生—麻醉学]