不同时机双管硬膜外分娩镇痛对母婴影响的比较  

Comparison of Effect of Labor Double- catheter Epidural Analgesia at Different Laboring Phases of Parturients and Neonates

作　　者：王向东[1] 张少卿[1] 周玉梅[1] 刘喻 

机构地区：[1]东莞市妇幼保健院麻醉科,广东东莞523000 [2]东莞市东华医院妇产科,广东东莞523000

出　　处：《黑龙江医学》2015年第4期352-354,共3页Heilongjiang Medical Journal

基　　金：东莞市科技计划医疗卫生类科研一般项目(201410515000689)

摘　　要：目的比较不同时机双管法硬膜外分娩镇痛对母婴的影响。方法自愿接受分娩镇痛的足月、单胎、头位初产妇120例,均采用L1-2,L4-5间隙硬膜外穿刺置管行双管法硬膜外分娩镇痛,根据开始分娩镇痛的时机分为2组（n=60）,A组：开始于活跃期（宫口扩张〉3.0 cm）,结束于宫口开全。B组：开始于潜伏期（宫口扩张〈3.0 cm）结束于胎儿娩出。同时随机选取不接受分娩镇痛的足月、单胎、头位初产妇60例为对照组（C组）。于镇痛前即刻（C组于宫口扩张3 cm时）、镇痛开始后10 min、30 min、宫口扩张7-8 cm及10 cm,第二产程中及胎儿娩出后行VAS评分,采用改良Bromage评分法测定下肢肌力。记录镇痛时间、产程时间、分娩方式、催产素使用情况、药物用量、胎儿娩出后1 min、5 min时Apgar评分、产妇满意度评分及不良反应发生情况。结果与C组比较,A组和B组镇痛开始后各时点VAS评分降低,第一产程时间缩短,催产素使用率升高,剖宫产率降低（P〈0.05）;B组和A组比较,第二产程VAS评分降低,产妇满意度评分提高,其余指标差异无统计学意义（P〉0.05）。结论双管法硬膜外分娩镇痛始于潜伏期,结束于胎儿娩出的全程分娩镇痛可提供更完善的镇痛,提高产妇满意度,且不延长产程,对新生儿同样安全。Objective To compare the effects of labor double- catheter epidural analgesia at different laboring phases of parturients and neonates. Methods 120 nutliparous women of full term pramipara were randomly divided into 3 groups（ n = 60 each） ： control group（ group C）; PCEA initiated in latent phase（ cervical dilatation 〈3. 0 cm） and ended in delivery of fetus group（ group B） and PCEA initiated in active phase（ cervical dilatation 〉3. 0 cm） and ended in cervical dilatation of 10 cm（ group A）. Group A and Group B interfered with double- catheter epidural block at the level of L1- 2and L3- 4. The intensity of pain was measured with VAS（ 0 = no pain,10： worst pain） before analgesia,at10 and 30 min after the beginning of PCEA and cervical dilatation of 7 - 8 cm and 10 cm,and VAS score was done. The length of every stage,duration of analgesia,delivery mode,the amount of oxytocin usage,amount of medicine,Apgar score after 1 and 5 rain after the delivery of baby,maternal satisfaction and adverse effect were recorded. Results In PCEA initiated in latent phase or active phase VAS score reduced significantly,the duration of 1st stage of labor reduced,and the rate of cesarean section increased,and the use of oxytoein reduced in A and B groups as compared with group C,but there was no significant difference in the variables above between A group and B group. Group B significantly reduced VAS score and increased maternal satisfaction on the duration of the 2nd stage of labor as compared with group A. Conclusion Labor double- catheter epidural analgesia initiating in latent phase and ending in delivery of fetus group can provide more comfortable analgesia and increase maternal satisfaction but do not prolong the duration of labor and be safe for the newborn.

关 键 词：双管硬膜外阻滞 镇痛 产科 罗哌卡因 

分 类 号：R714.3[医药卫生—妇产科学]