摘要
目的观察患者自控硬膜外分娩镇痛（patientcontrolledepiduralanalgesia，PCEA）对产程和分娩方式的影响，评估其安全性和可行性。方法选择无阴道分娩和椎管阻滞禁忌症的头胎足月初产妇100例，按病例对照研究的方法分为两组，每组50例。观察组在宫13开至3cm时行硬膜外阻滞，接装有0．1％的罗哌卡因复合0．5mg／L舒芬太尼的全自动电子输注泵，首次量6ml，持续量6ml／h-8ml／h，PCEA量为5ml，锁定时间为15min。对照组按产科常规处理，无PCEA。观察并记录各产程持续时间、分娩方式、缩宫素的使用、器械助产的情况、出血量及新生儿1min和5rainApgar评分。同时记录宫口开至3（T1）、8cm（L）、宫口开全时（T3）和胎儿娩出时（T4）产痛的视觉模拟评分（visualanalogμescale，VAS）。结果两组患者一般资料差异无统计学意义。第1产程与对照组（696±48）比较，观察组产妇（658±46）明显缩短（P〈0．05），而第2产程和第3产程差异无统计学意义。两组产妇在T2、T3、T4时点VAS评分观察组明显小于对照组【观察组为（1．3±0．5）、（1．2±0．7）、（1．9±0．6）；对照组为（7．3±0．7）、（6．5±1．2）、（3．6±0．4），P〈0．0011，T1时点由于还未实施镇痛所以对照组和观察组的评分比较高且无统计学意义。剖宫产率明显降低，观察组4％的剖宫产率明显少于对照组24％的剖宫产率。缩宫素使用明显增加，观察组缩宫素60％的使用率明显高于对照组30％的使用率。两组器械助产、产妇的失血量及新生儿1min和5minApgar评分差异均无统计学意义（P〉O．05）。结论0．1％罗哌卡因复合0．5mg／L舒芬太尼用于PCEA效果确切，可缩短第1产程且降低剖宫产率。
Objective To study the clinical effects of patient controlled epidural analgesia on the duration of labor, mode of delivery, and to evaluate the safety and feasibility of patient controlled epidural analgesia （PCEA）. Methods One hundred primigravidas at term without contraindications for vaginal delivery and epidural analgesia were assigned into two groups, observation group（OG） and control group（CG）, 50 each, using case control method. When the cervical dilations of patients reached 3 cm in the OG group, they received 0.1% ropivacaine plus sufentanil 0.5 mg/L. The PCEA setting was 6 ml/h-8 ml/h background dose, 5 ml for PCA-demand dose, 15 min lockout interval. The control group was treated with routine managements without PCEA. The duration of labor stages, mode of delivery, use of oxytocin and instrumental delivery were observed and documented. Visual analogue score （VAS） of pain was also recorded when cervical dilations were at 3 （%）,8 （T2）, and 10 cm （T3）, as well as at the end of the second stage （1＂4）. Results The duration of the first stage of labor was shorter （P〈0.05） in the OG group （658±46） than in the CG group （696±48）. The rate of score was lower （P〈0.001） in the OG group than in the CG group. The VAS of OG group at T2,T3,T4 were （1.3±0.5）, （1.2±0.7） and （1.9±0.6） respectively. While the VAS of CG group at Tz,T3,T4 were（7.3±0.7）, （6.5±1.2） and （3.6±0.4） respectively. When cervical dilation more than 3 era, however, the dose of oxytocin used for parturients in the OG （60%） group was higher （P〉0.05） than in CG group （30%）. There were no statistical differences with maternal bleeding and neonatal APGAR scores between the two groups. Conclusions Ropivacaine 0.1% plus sufentanil 0.5 mg/L used in PCEA for labor pain was effective. PCEA reduced the duration of first stdge labor and the rate of cesarean section.
出处
《国际麻醉学与复苏杂志》
CAS
2012年第12期811-813,852,共4页
International Journal of Anesthesiology and Resuscitation
关键词
分娩镇痛
患者自控硬膜外镇痛
产程
剖宫产率
舒芬太尼
Labor analgesia
Patient controlled epidural analgesia
Labor duration
Cesarean section
Sufentanil
