硬膜外麻醉分娩镇痛对母儿安全性的分析

发布时间：2018-05-28 22:25

本文选题：硬膜外麻醉 + 分娩镇痛　；参考：《皖南医学院》2017年硕士论文

【摘要】：研究背景:每位产妇都必须面临分娩时的产痛,关于产痛的严重程度,有人形容为仅次于烧灼痛,亦有人比喻为二十根骨头同时骨折的痛感。产妇因此产生焦虑,恐惧,痛苦,甚至绝望的心理,导致一系列神经内分泌反应,产妇易出现循环衰竭,酸中毒;胎盘血流量减少,胎儿宫内窘迫,甚至新生儿窒息等风险,最终影响产程及母儿的安全[1]。随着国内外医疗水平的发展,分娩镇痛即老百姓俗称的“无痛分娩”,可明显降低产妇分娩时疼痛,减轻产妇不良情绪,并无明显不良反应,已成为现代产科及麻醉科医师工作的重点课题。分娩镇痛技术历史悠久,起源于欧美发达国家,已有百年历史。美国,英国以及加拿大等欧美国家的分娩镇痛率均可达85%以上,剖宫产率均低于20%,而我国的分娩镇痛技术由于起步较晚,患者的顾虑及麻醉师的缺乏等多重因素,使分娩镇痛率低至1%以下,剖宫产率却超过50%[2]。随着二胎政策的放开,剖宫产率居高不下,产妇的关注度增高,减轻分娩疼痛,提高母儿分娩的安全等一系列因素,使分娩镇痛技术的研究和推广已刻不容缓。广义的分娩镇痛概念包括非药物镇痛及药物镇痛。前者主要包括导乐分娩,拉玛泽呼吸疗法,穴位镇痛,水中分娩,分娩球等,其缓解分娩疼痛程度有限;后者包括氧化亚氮吸入镇痛,全身麻醉及椎管内麻醉镇痛等。其中硬膜外麻醉分娩镇痛技术是应用最为广泛,并发症较少,较为安全有效,对母婴无不良影响的方法[3,4]。目的:剧烈的产痛对产妇生理及心理均产生不良影响,分娩镇痛技术的意义明显。随着国内多家医院先后开展分娩镇痛技术,该项技术对母儿是否安全,是产妇及妇产科医师,麻醉师共同关心的问题。本文通过0.0894%罗哌卡因复合0.5ug/ml舒芬太尼实施硬膜外分娩镇痛,观察其镇痛效果,对产程,产后出血量及母儿的影响。方法:选取2016年4月-2016年8月在芜湖市第二人民医院产科分娩,无产科及内外科疾病禁忌,阴道试产的产妇200例,根据干预方式的不同分为两组,观察组为志愿要求行0.0894%罗哌卡因复合0.5ug/ml舒芬太尼实施硬膜外分娩镇痛产妇100例和对照组为不使用镇痛方式的自然分娩的产妇100例。观察产妇疼痛判定[疼痛判定标准采用视觉模拟评分法(Visual Analogue Scale/Score,VAS)]、运动阻滞程度使用Bromage评分,第一产程、第二产程、第三产程的时间,催产素的使用率,产后2小时出血量,新生儿窒息,剖宫产率,产妇的不良反应及并发症。结果:分娩镇痛组较对照组疼痛明显减轻,镇痛后产程不同时段的VAS评分明显下降,差异有统计学意义(P0.05);催产素使用率增加,差异有统计学意义(P0.05),两组第一产程、第二产程、第三产程的时间,产后2小时出血量,新生儿评分,剖宫产率无显著差异(P0.05);两组产妇的不良反应及并发症:皮肤瘙痒,恶心呕吐,低血压,尿潴留,会阴水肿等无显著差异(P0.05);镇痛组运动神经阻滞轻微,Bromage评分两组无显著差异(P0.05)。结论:罗哌卡因复合舒芬太尼行硬膜外麻醉分娩镇痛技术,镇痛效果确切,不影响产程进展,对母儿无不良反应。此技术安全可靠,值得临床广泛运用。
[Abstract]:Background : Every woman must be faced with the pain of labor and the severity of pain , and it is described as the pain of the fracture of twenty bones only after burning pain . It also causes a series of neuroendocrine responses , such as circulatory failure , acidosis , reduced placental blood flow , fetal distress , and even neonatal asphyxia . With the development of medical treatment at home and abroad , labor analgesia is commonly called " painless labor " , which can significantly reduce the pain in the delivery of a woman , reduce the bad mood of the pregnant woman , and has no obvious adverse reaction , and has become the focus of the work of the modern obstetrics and anesthesiologist . The labor analgesia technique has a long history , which originated in the developed countries in Europe and America . The labor analgesia rate in the United States , the United Kingdom and Canada has been lower than 20 % , and the labor pain relief rate in China is lower to less than 1 % , and the cesarean section rate is more than 50 % . The analgesic effects of epidural anesthesia were studied by using 0 . 0894 % Ropias and 0 . 5ug / ml sufentanyl for epidural labor analgesia . No significant difference was found between the two groups ( P0.05 ) . Conclusion : The analgesic effect of epidural anesthesia with epidural anesthesia is exact and no adverse reaction is affected . This technique is safe and reliable , and it is worthy of clinical application .
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.3

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