硬-脊联合麻醉不同阶段镇痛对足月产妇分娩结局的影响

发布时间：2019-03-11 20:43

【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(P0.05);其降幅A组B组C组,差异有统计学意义(P0.05);三组产妇在第三产程对比上无统计学意义(P0.05);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(P0.05);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(P0.05);三组新生儿Apgar评分及难产率对比均无统计学意义(P0.05);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(P0.05)。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。
[Abstract]:Objective to investigate the effect of spinal-epidural anesthesia on labor outcome of full-term parturients. Methods from July 2013 to May 2014, 134 full-term parturients who received spinal-epidural combined anesthesia and analgesia in Guangming traditional Chinese Medicine Hospital in Pudong New area of Shanghai were selected as subjects and divided into latent period anesthesia group (group A) according to random number method. Group B (n = 67) and active anesthesia group (group B, n = 67). A total of 60 full-term parturients without labor analgesia were enrolled in the control group (group C, n = 60). The analgesic effects of three groups of parturients before analgesia puncture, 10 min, after infusion of anesthetic fluid and 30 min after infusion of anesthetic fluid were compared. The progress of labor process, mode of delivery and (Apgar), of newborn were recorded. Complications such as intrauterine distress and neonatal asphyxia. Results after continuous infusion of anesthetic solution, the VAS scores of the three groups were significantly lower than those before analgesia puncture (P0.05), and the extent of decrease was statistically significant in group A, group B and group C (P0.05). There was no significant difference in the third stage of labor among the three groups (P0.05); the cervical dilation rate of group A, group B, group C, and active stage, the second stage of labor, group A group B group C, the difference was statistically significant (P0.05); A, B, C group vaginal delivery rate were 89.6%, 74.6%, 63.3%, respectively, the difference was statistically significant (P0.05); there was no significant difference in neonatal Apgar score and dystocia rate among the three groups (P0.05); The incidence of intrauterine distress and neonatal asphyxia in group A and B was significantly lower than that in group C (P0.05). Conclusion the method of combined spinal-epidural anesthesia for labor analgesia in full-term parturients during the incubation period can obtain ideal analgesic effect. The parturient has no obvious prolongation of labor process and the mother-to-child outcome is ideal, so it is worth popularizing in clinical practice.
【作者单位】：上海市浦东新区光明中医医院麻醉科;
【分类号】：R614

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