脉冲波疗法用于分娩镇痛的临床效果分析

目的 探讨脉冲波疗法用于分娩镇痛的临床效果以及对产妇和新生儿的影响.方法 150例初产妇随机分成镇痛组和对照组,镇痛组在产程中使用GT-4A分娩镇痛工作站.观察两组产妇的镇痛效果、产程时间、分娩方式、产后出血及镇痛对母儿的影响,并将镇痛组与75例硬膜外自控镇痛的初产妇即PCEA组分娩方式及缩宫素使用率进行比较.结果 镇痛组镇痛前后疼痛评分差异有非常显著性(P＜0.01);镇痛组与对照组的活跃期、第一产程、第二产程时间比较差异有显著性(P＜0.005);镇痛组与对照组比较剖宫产率差异有显著性(P＜0.05),产程中缩宫素使用率差异无显著性(P＞0.05);镇痛组与对照组比较产后出血及新生儿评分等差异无显著性(P＞0.05).镇痛组与PCEA组比较缩宫素使用率及阴道助产率有显著性差异(P＜0.05),镇痛组明显低于PCEA组.结论 GT-4A分娩镇痛工作站为非药物非创伤性镇痛,具有良好的镇痛效果,可缩短产程,对母儿无不良影响,提高产妇对分娩的依从性,能降低剖宫产率,操作简单,产妇易于接受,是一种较为理想的分娩镇痛方法.     

160例分娩镇痛临床分析

目的:通过对160例产妇实施分娩镇痛,观察其临床效果,探讨分娩镇痛对产程及母儿的影响。方法:选择160例健康、单胎、足月临产自愿接受分娩镇痛的初产妇作为镇痛组,将条件相似未采用任何镇痛措施的自然临产产妇160例作为对照组,对镇痛效果、产程时间、分娩方式、新生儿Apgar评分、产后2小时出血的情况进行比较。结果:镇痛组总产程时间、第一产程时间较对照组显著缩短(P<0.01),两组分娩方式、产后2h出血量及新生儿Apgar评分差异无显著性(P>0.05)。结论:分娩镇痛能减轻孕妇宫缩疼痛程度,缩短产程,提高自然分娩的信心,对母儿无不良影响。     

笑气分娩镇痛对产程的影响

目的 探讨笑气吸入分娩镇痛促产程进展的效果及对母儿的影响。方法 将100例产妇在第一产程宫口开大3cm时间断吸入笑气镇痛作为观察组，另100例在产程中单纯吸入氧气作为对照组。观察两组产妇产程时间、分娩方式、产后出血及新生儿窒息情况。结果 观察组较对照组第一产程时间、总产程时间缩短（P〈0．001），剖宫产率下降（P〈0．01或P〈0．05），差异有显著性。两组产妇第二及第三产程时间、产后出血、新生儿窒息率比较，P〉0．05，差异无显著性。结论 笑气吸入用于分娩镇痛可减少孕妇分娩的痛苦，加速产程进展，降低剖宫产率，对母儿无不良影响，是一种简便、安全的分娩镇痛方法。     

连续硬膜外阻滞分娩镇痛联合产程管理对母婴的影响

目的:研究硬膜外分娩镇痛配合积极产程管理对分娩结局的影响。方法:选取2015年1至12月在新疆石河子妇幼保健院住院分娩的172例单胎足月孕妇,其中72例行连续硬膜外分娩镇痛配合积极产程管理(观察组),100例采取常规分娩(对照组)。结果:观察组产妇镇痛后各时间点数字评分法(NRS)评分均较对照组降低,差异有统计学意义(P0.05),镇痛起效时间(10.5±6.4)min。两组的活跃期及二产程时间、新生儿Apgar评分、出血量均无显著差异(P0.05);观察组的缩宫素使用率高于对照组(P0.05),剖宫产率低于对照组(P0.05)。结论:硬膜外分娩镇痛配合积极产程管理,镇痛效果确切,不延长产程,可降低剖宫产率,对母婴安全。     

不同麻醉药物应用于妊娠期高血压疾病患者的分娩镇痛比较

目的:研究不同麻醉药物应用于妊娠期高血压疾病分娩镇痛的临床效果。方法:90例符合妊娠期高血压疾病诊断标准的初产妇随机分成3组。以地西泮,布比卡因加芬太尼,罗哌卡因加芬太尼分别用于3组。观察产妇的分娩、镇痛情况及镇痛前后的血压及心率的变化。结果:①Ⅱ组和Ⅲ组镇痛效果与Ⅰ组相比较差异有非常显著性(P<0.01)。②镇痛后Ⅱ组和Ⅲ组血压明显降低,心率减慢,与Ⅰ组相比差异有非常显著性(P<0.01)。③3组产妇运动阻滞无统计学差异,但Ⅱ组运动阻滞要明显高于Ⅲ组。④Ⅲ组与Ⅰ组比较,第一产程活跃期明显缩短,差异有非常显著性(P<0.01)。器械助产、会阴侧切、正常分娩及缩宫素使用情况及新生儿Apgar评分3组产妇无统计学差异(P>0.05)。⑤中转剖宫产率Ⅰ组与Ⅱ、Ⅲ组比较差异有显著性。结论:硬膜外阻滞用于妊娠期高血压疾病分娩镇痛效果良好,降低剖宫产率。且罗哌卡因的运动阻滞轻微,第一产程及第二产程时间要低于布比卡因。所以,罗哌卡因更具优越性。     

不同时机实施分娩镇痛对妊娠期高血压疾病产妇产程、分娩方式及分娩结局的影响CSCD

目的 探讨在不同时机实施分娩镇痛对妊娠期高血压疾病(HDP)产妇产程、分娩方式及分娩结局的影响。方法 将2020年4月至2021年9月中国人民解放军联勤保障部队第九〇八医院鹰潭医疗区收治的138例HDP产妇随机分为Ⅰ组、Ⅱ组,Ⅰ组在潜伏期(宫口直径<3 cm)时实施分娩镇痛,Ⅱ组在活跃期(宫口直径≥3 cm)时实施分娩镇痛。采用视觉模拟疼痛评分(VAS)评估两组产妇不同时点镇痛效果,并观察记录产程进展、分娩方式、分娩结局及不良反应发生率。结果 镇痛后VAS评分下降,潜伏期VAS评分Ⅰ组低于Ⅱ组(P <0.05)。两组第一、第二、第三产程比较差异均无统计学意义(P>0.05);两组顺产率、剖宫产率、阴道助产率、不良反应的发生率比较差异均无统计学意义(P>0.05);两组新生儿窒息率、胎儿窘迫率、异常胎心率比较差异均无统计学意义(P>0.05)。结论 潜伏期对HDP产妇进行分娩镇痛不影响产程、分娩方式及分娩结局,不增加产妇分娩期间的不良反应,可尽早解除产妇痛苦。     

腰麻-硬膜外联合阻滞麻醉用于分娩镇痛的临床分析

目的探讨蛛网膜下腔-硬膜外联合阻滞麻醉（CSEA）进行分娩镇痛对母儿的影响。方法将200例（试验组）无产科并发症和麻醉禁忌证的初产妇分为自然临产组120例，缩宫素引产组80例；随机抽取同期条件相当，未实施分娩镇痛者200例也分别与镇痛组配为对照组，试验组在活跃初期使用小剂量低浓度麻醉药经蛛网膜下腔-硬膜外联合给药，观察用药后不良反应和镇痛效果以及对产程时间、分娩方式、产后出血、新生儿窒息、羊水性状的影响，并与200例对照组产妇相比较。结果试验组镇痛效果良好，未见明显不良反应，活跃期和第二产程缩短，此镇痛方式快速有效，不良反应少，能使活跃期明显加速，第二产程缩短；两组在产后出血、新生儿窒息、胎儿窘迫等方面差异无显著性。结论此镇痛方式快速有效，不良反应少，能使活跃期明显加速，缩短第二产程，降低剖宫产率，对母婴无不良影响，值得推广。     

可行走式无痛分娩的镇痛效果及其对母儿的影响

目的：分析可行走式无痛分娩的镇痛效果及其对母儿的影响。方法：回顾性分析2012年9月-2013年9月收治的177例孕产妇,按其分娩方式分为无痛分娩组（n=83）和常规分娩组（n=94）,比较2组产妇各产程疼痛评分、产程及新生儿情况。结果：无痛分娩组剖宫产率低于常规分娩组（P＜0.05）;无痛分娩组第一产程较常规分娩组缩短,其第二产程较常规分娩组延长（P＜0.05）,2组产妇第三产程差异无统计学意义（P＞0.05）;无痛分娩组产妇各产程视觉模拟评分法（VAS）评分均低于常规分娩组（P＜0.05）;2组胎儿窘迫发生率及Apgar评分差异均无统计学意义（P＞0.05）;2组产妇产后3 h出血发生率及出血量差异均无统计学意义（P＞0.05）;常规分娩组未见产后不良反应,无痛分娩组4例（5.6%）出现体位性低血压,3例（4.2%）下肢肌力减弱,均经对症治疗后于3 h内缓解。结论：可行走式无痛分娩具有良好的镇痛效果,可显著降低产妇各产程的疼痛感觉,且不会发生严重产后并发症,对胎儿无害,是一种有效、安全的分娩镇痛方式,值得临床推广应用。     

笑气吸入用于分娩镇痛的有效性与安全性研究

目的　探讨笑气吸入分娩镇痛的有效性与安全性。方法　将 130 0例单胎头位、足月初产妇分为两组。其中 ,研究组 6 5 8例 ,在产程中吸入 5 0 %笑气与 5 0 %氧气的混合气体实行分娩镇痛 ;对照组 6 4 2例 ,产程中间断吸入氧气。观察两组产妇疼痛的缓解程度、产程时间、分娩方式、羊水情况、分娩失血量、新生儿出生时的Apgar评分、产妇桡动脉与新生儿脐动脉血气分析的结果、笑气吸入的副反应。结果　研究组产妇分娩镇痛的有效率为 80 9% ,总产程时间为 4 6 8min ,活跃期时间为 15 3min ,剖宫产率为 11 6 % ,羊水污染率 2 2 0 % ,新生儿窒息率 1 2 % ,产时出血平均 2 37ml,39 4 %的产妇出现头晕表现的副反应 ;而对照组产妇分娩镇痛的有效率为 0 9% ,活跃期时间为 187min ,剖宫产率为 19 3% ,与研究组比较 ,差异有显著性 (P <0 0 5 ) ;而产程时间 4 80min ,羊水污染率 2 4 3% ,新生儿窒息率 1 7% ,产时出血平均 2 5 3ml,与研究组比较 ,差异无显著性 (P >0 0 5 ) ;对照组产妇无明显的头晕等副反应。两组产妇桡动脉及脐动脉血气分析结果比较 ,差异无显著性 (P >0 0 5 )。结论　 5 0 %笑气与 5 0 %氧气的混合气体用于分娩镇痛安全方便 ,易被产妇接受 ,可有效地缓解分娩疼痛 ,增加阴道分娩率 ,对产程及母儿     

导乐陪伴分娩联合自控式硬膜外分娩镇痛对产程及母儿影响的观察

目的观察产时陪伴分娩结合自控硬膜外分娩镇痛对产程进展、分娩方式及新生儿窒息等的影响。方法随机选择自愿要求行单纯导乐陪伴分娩初产妇100例为观察A组,自愿要求行导乐陪伴分娩+自控式硬膜外分娩镇痛初产妇100例为观察B组,同期无导乐陪伴及自控式硬膜外镇痛分娩初产妇100例为对照C组,对阴道分娩产程、分娩方式、产程中缩宫素应用情况、产后出血量、新生儿窒息等进行分析。结果 A组与B、C组比较,表现为第一产程明显缩短(P<0.01),以活跃期缩短最为显著(P<0.001);B、C组间比较,B组缩宫素或人工破膜使用情况率明显增高(P<0.05),剖宫产率明显降低(P<0.05);A组与C组比较,剖宫产率显著降低(P<0.01)。结论单纯陪伴分娩可减轻疼痛、缩短第一产程活跃期,陪伴分娩结合自控硬膜外分娩镇痛可以达到显著镇痛效果,可以明显减低剖宫产率,对产后出血量,新生儿窒息等无影响。     

Anxiety assessment in parturients requesting epidural analgesia for pain relief

OBJECTIVES: Neuraxial methods provide the most effective labor pain relief. This study aimed at assessing anxiety level in parturients requesting epidural analgesia (EA). MATERIAL AND METHODS: Forty five women in spontaneous, active labor were enrolled, both primiparas (n=36) and multiparas (n=9). Anxiety was assessed by means of Spielberger State and Trait Anxiety Inventory (STAI) before administration of EA, and pain was measured by visual-analog scale (VAS) before and after analgesia. RESULTS: In all the studied parturients state anxiety was strikingly higher than the trait (53.9 +/- 11.8 vs. 39.3 +/- 8.4; P < 0.0001); the difference appeared insignificant in multiparas only. State anxiety was comparable independently of parity, labor outcome and systemic opioid administration. No association between anxiety level and labor pain intensity preceding analgesia, the duration of labor stages and demographic parameters could be found. However, a negative correlation between state anxiety and pain intensity reported after EA administration was noted (R = -0.315, p = 0.040), and, in cases of physiological labor, a negative association between state anxiety and the neonate Apgar score at the 1st minute after birth could be observed (R = -0.337, p = 0.047, Spearman rank test). CONCLUSIONS: In parturients requesting EA, state anxiety level is increased and not connected with the trait. Furthermore, in these women, anxiety appears not to be associated with labor pain but may influence the analgesic effect of the blockade. Anxiety does not determine labor duration and outcome; however, it may be connected with the well-being of the neonate immediately after birth.     

Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome]

BACKGROUND: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome. METHODS: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group. RESULTS: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA. CONCLUSIONS: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.     

Acupuncture in the management of pain in labor

BACKGROUND: To assess if acupuncture could be a reasonable option for pain relief in labor and to look at possible effects of acupuncture on the progress of labor. METHODS: In a controlled, single blind study, 210 healthy parturients in spontaneous, active labor at term were randomly assigned to receive either real acupuncture or false acupuncture. Visual analog scale assessments were used to evaluate subjective effect on pain. The objective parameter of outcome was the need for analgesic medication in each group. RESULTS: There were significantly lower mean pain scores and significantly less need for pharmacological analgesia in the study group compared with the control group. The women given real acupuncture spent less time in active labor and needed less augmentation than the control group. CONCLUSION: The results indicate that acupuncture reduces the experience of pain in labor. A secondary outcome of acupuncture was a shorter delivery time, which mainly, if not exclusively, can be explained by the reduced need for epidural analgesia. Acupuncture may be useful for parturients who wish a nonpharmacological analgesia without side-effects. For others it could be the analgesic method of choice, with pharmacological analgesics as supplements.     

间苯三酚联合硬膜外麻醉分娩镇痛的临床研究

目的探讨间苯三酚联合硬膜外麻醉在分娩过程中,促进产程进展、减轻分娩疼痛等的效果。方法将180例初产妇随机分为3组各60例,在孕妇宫口开大约3cm以上,实验组采用间苯三酚80mg静脉推注联合硬膜外麻醉行无痛分娩,对照1组单纯采用间苯三酚80mg静脉推注;对照2组单纯采用硬膜外腔阻滞麻醉。比较在用药后1h的镇痛效果及产妇运动能力,第一产程活跃期时间、剖宫产率、产后出血量、血氧饱和度和新生儿评分等母儿结局。结果对照1组第一产程活跃期时间、剖宫产率与实验组相比,差异无统计学意义（P〉0.05）,但镇痛效果差。对照2组镇痛效果良好,但第一产程活跃期较对照1组和实验组时间明显延长,剖宫产率相对增加,差异有统计学意义（P〈0.05）。结论间苯三酚联合硬膜外麻醉缩短产程效果明显,镇痛效果良好,对母婴无不良反应,减少了剖宫产。     

Safety and risks of nitrous oxide labor analgesia: a review

Introduction: This review of the safety and risks of nitrous oxide (N₂O) labor analgesia presents results of a search for evidence of its effects on labor, the mother, the fetus, the neonate, breastfeeding, and maternal‐infant bonding. Concerns about apoptotic damage to the brains of immature mammals exposed to high doses of N₂O during late gestation, possible cardiovascular risks from hyperhomocysteinemia caused by N₂O, a hypothesis that children exposed to N₂O during birth are more likely to become addicted to amphetamine drugs as adults, and possible occupational risks for those who provide care to women using N₂O/O₂ labor analgesia are discussed in detail. Methods: Research relevant to the 4 special concerns and to the effects of N₂O analgesia on labor and the mother‐child dyad were examined in depth. Three recent reviews of the biologic, toxicologic, anesthetic, analgesic, and anxiolytic effects of N₂O; 3 reviews of the safety of 50% N₂O/oxygen (O₂) in providing analgesia in a variety of health care settings; and a 2002 systematic review of N₂O/O₂ labor analgesia were used. Results: Nitrous oxide analgesia is safe for mothers, neonates, and those who care for women during childbirth if the N₂O is delivered as a 50% blend with O₂, is self‐administered, and good occupational hygiene is practiced. Because of the strong correlation between dose and harm from exposure to N₂O, concerns based on effects of long exposure to high anesthetic‐level doses of N₂O have only tenuous, hypothetical pertinence to the safety of N₂O/O₂ labor analgesia. Discussion: Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of endogenous oxytocin, and has no adverse effects on the normal physiology and progress of labor.     

What determines the analgesic effect of paracervical block?

BACKGROUND: The objective of the study was to evaluate the analgesic effect of paracervical block (PCB) in labor pain relief and to discover the determinants associated with good analgesia. METHODS: In a prospective trial, 341 women received PCB for pain relief in the first stage of labor, with 10 ml of 0.25% levobupivacaine or racemic bupivacaine. All these pregnancies were uncomplicated and the progress of labor was normal. The analgesic effect of PCB was measured by using a visual analog scale (VAS). The factors associated with good pain relief (>50% decrease in the VAS score within 30 min) were analyzed statistically by Student's t-test or the Mann-Whitney test (continuous variables), Fisher's exact test (categorial variables) and after univariate analysis by logistic regression analysis. For pairwise comparisons, Wilcoxon's signed ranks test was used. RESULTS: Good pain relief was achieved in 47.2% of the cases. 12.3% of the parturients needed subsequent epidural or spinal analgesia. In logistic regression analysis, primiparity, a high pain score before PCB, and PCB given by a specialized obstetrician were found to affect the level of pain relief 30 min after PCB. CONCLUSIONS: The best pain relief after PCB was achieved among primiparas. Good pain relief was connected with a high pain score before PCB and an experienced obstetrician.     

Effects of epidural fentanyl on labor pain during the early period of the first stage of induced labor in nulliparous women.

BACKGROUND AND PURPOSE: It is generally accepted that epidural injection with local anesthetics and narcotics administered when the cervix has dilated to a diameter exceeding 4 cm can adequately control labor pain. However, many nulliparous women still suffer from labor pain for a few hours prior to the administration of epidural analgesia. This study examined the effectiveness of relief of labor pain obtained by injection of narcotics epidurally once the labor pain begins and the subject requests analgesia. METHODS: Subjects scheduled for induced labour were divided into three groups: Group A (n = 60) received 5 x 10(-4)% fentanyl (10-20 mL) administered epidurally to relieve early first-stage labor pain. Group B (n = 60) received no analgesic in the early first stage of labor. For groups A and B, when cervical dilatation exceeded 4 cm, 10 to 15 mL of 5 x 10(-2)% bupivacaine and 2 x 10(-4)% fentanyl were injected epidurally and a continuous low dosage was maintained until full dilatation of the cervix resulted. Group C (n = 198) received no analgesic during the entire labor course. RESULTS: There were no significant differences in the duration of the early period of the first stage of labor, the duration of the late period of the first stage, the duration of the second stage, the Apgar score, or the arterial blood gas of neonates among the three groups. However, group C had a significantly higher cesarean section rate (28.8%) than group A (16.7%) or group B (15%). Pain scores assessed with the Visual Analog Scale (VAS) throughout the entire labor course, were lower in group A than in group B; particularly during the early period of the first stage. The VAS scores in both groups A and B were significantly lower than those in group C during the late period of the first stage of labor. CONCLUSIONS: The results indicate that once labor pain begins and the subject requests analgesia, epidural injection with fentanyl alone can relieve labor pain during the early period of the first stage. The analgesia does not cause adverse effects to the mothers or neonates. In addition, the labor course and the method of delivery are not affected.     

Anesthesia and analgesia for labor.

Epidural analgesia remains the mainstay for providing pain relief during labor. The search continues to find the ideal combination of analgesic agents and administration techniques that will provide excellent pain relief for the mother yet minimize side effects to the mother and fetus. This article reviews recent studies of epidural analgesia, including the increased use of epidural opioids, patient-controlled epidural analgesia, and the complications of epidural analgesia (including effects on gastric emptying, maternal temperature control, and hemodynamic changes to the mother and fetus). Intrathecal (spinal) analgesia, especially using opioids, is also discussed.     

Immersion in Water in the First Stage of Labor: A Randomized Controlled Trial

Background: Current forms of analgesia often have significant side effects for women in labor. Bathing in warm water during labor has been reported to increase a woman's comfort level and cause a reduction in painful contractions. The objective of this trial was to compare immersion in warm water during labor with traditional pain management for a range of clinical and psychological outcomes. Methods: A prospective randomized controlled trial of 274 pregnant women, who were free from medical and obstetric complications and expecting a singleton pregnancy at term, was conducted at the Women's and Children's Hospital, a maternity tertiary referral center in Adelaide, South Australia. Women in labor were randomized to an experimental group who received immersion in a bath or to a nonbath group who received routine care. Pharmacological pain relief was the primary outcome that was measured, and secondary outcomes included maternal and neonatal clinical outcomes, factors relating to maternal and neonatal infectious morbidity, psychological outcomes, and satisfaction with care. Results: The use of pharmacological analgesia was similar for both the experimental and control groups; 85 and 77 percent, respectively, used major analgesia. No statistical differences were observed in the proportion of women requiring induction and augmentation of labor or in rates of perineal trauma, length of labor, mode of delivery, or frequency of cardiotocographic trace abnormalities. Neonatal outcomes (birthweight, Apgar score, nursery care, meconium‐stained liquor, cord pH estimations) revealed no statistically significant differences. Infants of bath group women required significantly more resuscitation than routine group women. Routine group women rated their overall experience of childbirth more positively than bath group women. Psychological outcomes, such as satisfaction with care or postnatal distress, were the same for both groups. Conclusion: Bathing in labor confers no clear benefits for the laboring woman but may contribute to adverse effects in the neonate.