摘要
目的 通过对活跃期、第二产程疼痛感受的观察 ,从生理分娩的角度 ,研究不同产程镇痛的必要性。方法 选择有阴道分娩指征单胎足月初产妇 12 0例 ,自愿接受无痛分娩的产妇作为试验组 (n =6 0 )进行硬膜外镇痛 ,不愿接受无痛分娩的产妇作为对照组 (n =6 0 )。试验组硬膜外注射罗呱卡因 +芬太尼 ,然后连接产妇自控硬膜外镇痛泵输注。进入第二产程前半小时 (宫口开至 8cm)关闭镇痛泵 ,第二产程处于无镇痛状态。结果 活跃期 ,试验组、对照组视觉模拟评分法分别是 (0 .5 8± 0 .70 )cm、(6 .77± 1.89)cm ,与对照组比较 ,显著减低 (P <0 .0 1) ;第二产程 ,试验组视觉模拟评分法评分 (0 .90± 1.0 4 )cm与对照组 (1.2 2± 1.94 )cm相比 ,无显著性差异 (P =0 .12 ) ;第二产程试验组与对照组产妇满意度无显著性差异 (P =0 .2 7) ;试验组活跃期 (2 .80± 0 .75 )h、第二产程 (43.72± 2 5 .86 )min较对照组活跃期 (3.77± 0 .95 )h、第二产程 (6 4 .0 7± 2 2 .37)min都有显著缩短 (P <0 .0 1) ;新生儿各时点Apgar评分 ,试验组与对照组无差异 (P >0 .0 5 ) ;与对照组比较 ,试验组的产钳分娩率升高而剖宫产率降低 (P<0 .0 5 )。结论 第一产程活跃期镇痛能有效解除分娩疼痛 ,促进产程的进展 ,降低剖宫产率 ;进入?
Objective To study the necessity of analgesia during different stages of labor, from angle of physiological labor on the basis of observation on perception of p ain of parturients during active stage and the second s tage of labor. Methods One hundred and twenty full term primiparae in active stage who had a single fetus with vertex presentation and were expected to have vaginal delive ry were divided into two groups (60 each group): the parturients in study group received epidural analge sia (EA) + patient controlled epidural analgesia (PCEA) with Ropivacaine and Fen tanyl. When the external cervical os dilated to 3 cm,analgesia was began an d ahead of half an hour before the second stage of labor when the ex ternal cervical os dilated to 8cm analgesia was stopped. During the second stag e of labor, the partur ients received no any anesthetics. The parturients in control gr oup received no analgesia of any kind. Results In active stage of lab or, the VAS score was significantly lower in study group (0.58±0.70cm) than tha t in control group(6.77±1.89cm) (P<0.01);The VAS score in study group(0.90 ±1.04cm) was lower as compared with control group(1.22±1.94cm) in the second s tage of labor, but there was no significant difference(P=0.12) between the t wo groups; The durations of active stage(2.80±0.75h) and the second stage of labor(43.72±25.86min) were shorter in study group than those in control group(3 .77±0.95h) ,(64.07±22.37min) (P<0.01); Th ere were no significant difference in 1min and 5min Apgar scores for neonates be tween study group and control group; The rate of instrumental delivery was significantly higher a nd rate of cesarean section was significantly lower in study group than those in control group. Conclusion Analgesia during active stage of labor c an effectively relieve pain, promote the progression of labor, benefit instrume ntal delivery and reduce the rate of cesarean section. It is unnecessary to perf orm analg esia during the second stage of labor because the perception of pain would be co unteracted when parturients keep actively strain to delivery fetus, so analgesi a could be stopped ahead of half an hour before the second stage of labor.
出处
《国外医学（妇幼保健分册）》
2005年第1期4-6,共3页
Foreign Medical Sciences (Section of Maternal and Child Health)
关键词
分娩
镇痛
产程
疼痛感受
labor
analgesia
stage of laber
perception of pain
