硬膜外自控镇痛在自然分娩中的应用效果  

APPLICATION EFFECT OF PATIENT-CONTROLLED EPIDURAL ANALGESIA IN NATURAL LABOR

作　　者：颜廷媛 王俊环[1] 唐润栋 崔雪娜[1] 丁秀欣 徐金娥[1] YAN Tingyuan;WANG Junhuan;TANG Rundong;CUI Xuena;DING Xiuxin;XU Jin′e(Department of Obstetrics,The Affiliated Hospital of Qingdao University,Qingdao 266061,China)

机构地区：[1]青岛大学附属医院产科,山东青岛266061 [2]青岛大学附属医院麻醉科,山东青岛266061

出　　处：《精准医学杂志》2020年第1期57-59,64,共4页Journal of Precision Medicine

基　　金：国家自然科学基金项目(8197060938);青岛市科技计划基础研究项目(13-1-4-157-jch)。

摘　　要：目的探讨硬膜外自控镇痛(PCEA)在自然分娩过程中的镇痛效果及对孕妇产程、血液中缩宫素水平和新生儿的影响。方法选择2018年6月-2019年1月在我院产科要求自然分娩的符合要求的孕妇,根据分娩过程中是否镇痛分为观察组(行PCEA)和对照组(未行PCEA)。分别于宫口开大于3 cm时(T1)、T1后60 min时(T2)采集孕妇肘静脉血,检测血浆中缩宫素水平,计算两个时间点缩宫素浓度的差值;同时记录两组孕妇T2时的疼痛视觉模拟评分(VAS评分)、第一与二产程时间、新生儿1 min和5 min Apgar评分。结果两组孕妇血液中缩宫素水平差值比较,差异有显著性(t=11.34,P<0.01);观察组第一、二产程时间长于对照组,差异均有统计学意义(t=6.69,7.44,P<0.05);T2时,两组孕妇VAS评分差异显著性(t=10.57,P<0.01);两组新生儿出生后1 min和5 min Apgar评分差异无统计学意义(P>0.05)。结论PCEA在自然分娩中的镇痛效果显著,对新生儿无不良影响,PCEA可能抑制孕妇血液中缩宫素的分泌并使第一、二产程延长。Objective To investigate the analgesic effect of patient-controlled epidural analgesia(PCEA)in the course of natural labor and its influence on the course of labor,the level of oxytocin in the blood,and neonates.Methods The pregnant women who required natural labor and met related criteria in Department of Obstetrics in our hospital from June 2018 to January 2019 were enrolled,and according to whether analgesia was used during labor,they were divided into observation group(receiving PCEA)and control group(without PCEA).Cubital venous blood samples were collected when the uterine opening was more than 3 cm(T1)and at 60 min after T1(T2)to measure the plasma level of oxytocin and calculate the difference in oxytocin concentration between these two time points;meanwhile,Visual Analogue Scale(VAS)pain score,durations of the first and second stages of labor,and 1-and 5-min Apgar scores of the neonate were recorded.Results There was a significant difference in the change in blood oxytocin between the two groups(t=11.34,P<0.01),and the observation group significantly longer durations of the first and second stages of labor than the control group(t=6.69,7.44,P<0.05).There was a significant difference in VAS score between the two groups at T2(t=10.57,P<0.01),while there were no significant differences in 1-and 5-min Apgar scores between the two groups(P>0.05).Conclusion PCEA has a significant analgesic effect in natural labor and has no adverse effect on neonates.PCEA may inhibit the secretion of oxytocin in the blood of pregnant women and prolong the first and second stages of labor.

关 键 词：麻醉 硬膜外 镇痛 病人控制 催产素 罗哌卡因 舒芬太尼 产程 第一 产程 第二 疼痛测定 新生儿筛查 

分 类 号：R714.3[医药卫生—妇产科学] R614.42[医药卫生—临床医学]