连续硬膜外麻醉和腰麻-硬膜外麻醉对阴道分娩镇痛效果和脐带动脉血气的影响  

Effect of epidural anesthesia and lumbar anesthesia on spontaneous vaginal delivery analgesia and neonatal blood gases

作　　者：邢允光[1] 王威[1] 郭芳芳[1] XING Yunguang;WANG Wei;GUO Fangfang(Obstetrics department,Shenzhen Longgang District Maternal and Child Health Care Hospital,Guangdong 518100,China)

机构地区：[1]广东省深圳市龙岗区妇幼保健院产科,518100

出　　处：《中国煤炭工业医学杂志》2024年第3期270-274,共5页Chinese Journal of Coal Industry Medicine

基　　金：2023年度广东省基础与应用基础研究基金自然科学基金[编号:粤基金字(2023)2号]。

摘　　要：目的研究连续硬膜外麻醉和腰麻-硬膜外麻醉(腰硬联合麻醉)对阴道分娩镇痛效果和脐动脉血气的影响。方法选取2022年6月—2023年6月在该院选择自然阴道分娩的产妇208例,依据采用的麻醉方式不同分为观察组和对照组,各104例。对照组采取连续硬膜外麻醉,观察组采取腰硬联合麻醉,记录二组镇痛前(T0)、第一产程结束时(T1)、第二产程结束时(T2)、第三产程结束时(T3)的视觉模拟量表评分(VAS),各产程及总产程时间,以及新生儿血气指标,并统计二组妊娠结局及产后不良反应。结果观察组T1时刻的VAS评分为(3.13±0.72)分、T2时刻的VAS评分为(3.85±0.88)分、T3时刻的VAS评分为(5.28±1.15)分,均低于对照组,差异有统计学意义(P<0.05)。观察组第一产程时间为(458.85±113.73)min,总产程时间为(513.02±133.73)min,均低于对照组,差异有统计学意义(P<0.05)。观察组缓冲碱(BB)水平为(40.46±2.44)、碱剩余(BE)水平为(-5.33±1.72)、乳酸(LAC)水平为(4.45±1.58)mmol/L、PH值为(7.30±0.06),与对照组比较,差异均无统计学意义(P>0.05)。观察组自然分娩95例,机械助产5例,剖宫产4例,采用会阴切开术13例,Apgar评分为(9.11±0.25)分,与对照组比较,差异均无统计学意义(P>0.05)。观察组发生恶心呕吐9例,瘙痒10例,低血压8例,呼吸抑制2例,运动阻滞13例,与对照组比较,差异均无统计学意义(P>0.05)。结论相较于连续硬膜外麻醉,腰硬联合麻醉可能更好地改善镇痛效果,缩短产程时间,两者对新生儿血气的影响相近。Objective To study the effects of epidural anesthesia and lumbar anesthesia on natural vaginal delivery analgesia and neonatal blood gas.Methods We selected two hundred and eight natural vaginal delivery cases from June 2022 to June 2023,which were divided into observation group and control group according to the different anesthesia methods used,one hundred and four cases in each.Control group take epidural anesthesia,observation group take combined lumbar anesthesia-epidural anesthesia,The visual analogue scale(VAS)before analgesia(T0),at the end of the first stage of labor(T1),at the end of the second stage of labor(T2)and at the end of the third stage of labor(T3),the duration of each stage of labor and the neonatal blood gas index were recorded,and the pregnancy outcome and postpartum adverse reactions of the two groups were counted.Results The VAS scores in observation group were(3.13±0.72)at T1,(3.85±0.88)at T2 and(5.28±1.15)at T3,which were lower than those in control group,and the differences were statistically significant(P<0.05).The first labor time in observation group was(458.85±113.73)min,and the total labor time was(513.02±133.73)min,both of which were lower than those in control group,and the difference was statistically significant(P<0.05).In observation group,the level of buffer alkali(BB)was(40.46±2.44),the level of alkali residue(BE)was(-5.33±1.72),the level of lactic acid(LAC)was(4.45±1.58)mmol/L,and PH value was(7.30±0.06),and there was no difference compared with control group(P>0.05).In observation group,there were 95 cases of natural delivery,5 cases of mechanical midw-ifery,4 cases of cesarean section,and 13 cases of perineum incision.The Apgar score was(9.11±0.25),and there was no significant difference compared with control group(P>0.05).There were 9 cases of nausea and vomiting,10 cases of pruritus,8 cases of hypotension,2 cases of respiratory depression and 13 cases of motor block in observation group,and there was no significant difference compared with control group(P>0.0

关 键 词：连续硬膜外麻醉 腰硬联合麻醉 阴道分娩 分娩镇痛 脐动脉血气 

分 类 号：R714.3[医药卫生—妇产科学]