硬-脊联合麻醉不同阶段镇痛对足月产妇分娩结局的影响  

Effect of spinal epidural combined anesthesia on delivery outcomes of full-term pregnant women at different stages of analgesia

作　　者：李香盛 魏秀举 王开勇 

机构地区：[1]上海市浦东新区光明中医医院麻醉科,上海201399

出　　处：《热带医学杂志》2016年第9期1141-1144,共4页Journal of Tropical Medicine

摘　　要：目的探讨脊麻-硬膜外联合麻醉不同阶段镇痛对足月产妇分娩结局的影响差异。方法选取2013年7月至2014年5月于上海市浦东新区光明中医医院接受脊麻-硬膜外联合麻醉分娩镇痛方案的134例足月产妇为研究对象,按照随机数字法分成潜伏期麻醉组(A组,n=67)和活跃期麻醉组(B组,n=67)。将同期入院分娩的60例未予以分娩镇痛措施足月产妇纳入对照组(C组,n=60)。比对三组产妇镇痛穿刺前、泵注麻醉液后10 min、泵注麻醉液后30 min等时段内镇痛效果差异,记录其产程进展、分娩方式、新生儿阿氏评分(Apgar)、宫内窘迫及新生儿窒息等并发症发生情况。结果微量泵持续泵入麻醉液后,三组产妇VAS评分均较镇痛穿刺前显著降低,差异有统计学意义(P<0.05);其降幅A组>B组>C组,差异有统计学意义(P<0.05);三组产妇在第三产程对比上无统计学意义(P>0.05);宫颈口扩张速度A组>B组>C组,且活跃期、第二产程均A组<B组<C组,差异有统计学意义(P<0.05);A、B、C组产妇阴道顺产率分别为89.6%、74.6%、63.3%,差异有统计学意义(P<0.05);三组新生儿Apgar评分及难产率对比均无统计学意义(P>0.05);其中A、B组新生儿宫内窘迫及新生儿窒息发生率均显著低于C组,差异有统计学意义(P<0.05)。结论在潜伏期予以足月产妇脊麻-硬膜外联合麻醉分娩镇痛方案,可获得理想的镇痛效果,产妇产程无明显延长且母婴结局理想,值得临床推广。Objective To investigate the effect of different stages of analgesia on the delivery outcomes of full-term pregnant women with spinal epidural combined anesthesia. Methods 134 full-term pregnant women receiving spinal epidural combined anesthesia for labor analgesia in our hospital during July 2013 to May 2014 were selected as the research objects.According to the order of delivery, the objects were divided into the latency anesthesia group（group A,n =67） and the active phase anesthesia group（group B,n =67）. Another 60 cases of full-term pregnant women admitted into the hospital during the same period and without delivery analgesia measures were included in the control group（group C,n=60）. The analgesic effect of the three groups before analgesic puncture, 10 min and 30 min after infusion of anaesthetic liquid and in other periods of time was compared. The differences in progress of labor, mode of delivery,neonatal Apgar score, incidence rates of fetal distress, neonatal asphyxia andother complications were recorded. Results After continuous pumping of the anesthesic liquid by micro-pump, VAS scores of the three groups were significantly lower than those before analgesic puncture and the differences were statistically significant（P〈0.05）. The decline in group A was the greatest, followed by group B and group C and the differences were statistically significant（P〈0.05）.There was no statistically significant differences in the third stage of labor of the three groups（P〉0.05）. The cervical dilation rate of group A was the fastest, followed by group B and then by group C.The active phase and the second stage of labor of group A were significantly lower than those in group B and group C（P〈0.05）.The vaginal delivery rate of group A was 89.6% which was the highest among the three groups, followed by 74.6% of group B and 63.3% of group C;the differences were statistically significant（P〈0.05）.The differences of Apgar scores and dystocia rate of the three groups of newborns were no

关 键 词：脊麻-硬膜外联合麻醉 镇痛 足月产妇 分娩结局 

分 类 号：R614.42[医药卫生—麻醉学]