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分娩潜伏期硬膜外镇痛对产妇和新生儿的影响

     

摘要

目的 探讨分娩潜伏期行硬膜外镇痛对产妇和新生儿的影响.方法 将开封市妇产医院2015年12月至2017年1月自然临产并接受分娩镇痛的240例初产妇分为观察组和对照组,每组120例.观察组产妇在分娩潜伏期开始行硬膜外自控分娩镇痛(PCEA),对照组产妇在分娩活跃期开始行PCEA,2组产妇均在麻醉穿刺成功后给予甲磺酸罗哌卡因、枸橼酸舒芬太尼混合液10~15 mL注入硬膜外腔,然后采用自控镇痛泵行PCEA.观察2组产妇的第1产程时间(T 1)、第2产程时间(T 2)和视觉模拟法(VAS)评分、中转剖宫产及镇痛满意情况,并比较2组产妇镇痛期间血压、心率及新生儿Apgar评分、窒息率.结果 观察组产妇T 1、T 2显著短于对照组(P<0.05),VAS评分显著低于对照组(P<0.05).2组产妇镇痛期间血压和心率比较差异无统计学意义(P>0.05).对照组产妇中转剖宫产率、镇痛满意率分别为10.83%、70.83%,观察组产妇中转剖宫产率、镇痛满意率分别为3.33%、95.83%,观察组产妇中转剖宫产率显著低于对照组(χ2=5.128,P<0.05),镇痛满意率显著高于对照组(χ2=27.000,P<0.05).2组新生儿Apgar评分比较差异无统计学意义(P>0.05).对照组和观察组新生儿窒息率分别为3.0%和2.5%,2组新生儿窒息率比较差异无统计学意义(χ2=0.147,P>0.05).结论 产妇在分娩潜伏期行硬膜外镇痛效果满意,并可缩短产程,降低剖宫产率,且不增加母婴风险.%Objective To investigate the effects of epidural labor analgesia in latent phase on the puerperae and their newborns. Methods A total of 240 spontaneous parturient primiparae who received labor analgesia were selected from Decem-ber 2015 to January 2017 in Kaifeng Obstetrics and Gynecology Hospital. The primiparae were divided into observation group and control group,with 120 cases in each group. The puerperae in the observation group were performed with patient-controlled epidural analgesia(PCEA)in the latent phase,and the puerperae in the control group were performed with PCEA in the active phase. The puerperae received PCEA with 10 - 15 mL mixed liquor of ropivacaine mesylate and sufentanil citrate by self-con-trolled analgesia pump after epidural puncture. The time of the first stage of labor(T 1 ),the time of the second stage of labor (T2),visual analogue scale(VAS)score,uterine-incision delivery and the satisfaction degree of analgesia were observed. The blood pressure and heart rate of puerperae during the period of analgesia,and the neonatal Apgar score,the incidence of neo-natal asphyxia were compared between the two groups. Results The T1 and T2 of parturient in the observation group were sig-nificantly shorter than those in the control group (P < 0. 05),and the VAS score was significantly lower than that in the control group (P < 0. 05). There was no significant difference in blood pressure and heart rate between the two groups during the anal-gesia period (P > 0. 05). In the control group,the rate of cesarean section and the satisfaction of analgesia were 10. 83% and 70. 83% respectively;the rate of cesarean section and the satisfaction of analgesia were 3. 33% and 95. 83% respectively in the observation group. The rate of cesarean section in the observation group was significantly lower than that in the control group (χ2 = 5. 128,P < 0. 05),and the satisfactory rate of analgesia was significantly higher than that in the control group (χ2 = 27. 000,P < 0. 05). There was no significant difference in Apgar score of neonate between the two groups (P > 0. 05). Neonatal asphyxia rates in control group and observation group was 3. 0% and 2. 5% respectively;there was no significant difference in asphyxia rate between the two groups (χ2 = 0. 147,P > 0. 05). Conclusion The effect of epidural labor analgesia in latent phase is satisfactory. It can shorten the birth process and reduce the rate of cesarean section,and the maternal and in-fant risk is not increased.

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