11250例硬膜外病人自控分娩镇痛临床应用状况分析

目的：回顾分析低浓度罗哌卡因复合舒芬太尼硬膜外自控镇痛在不同时机用于分娩镇痛的效果及对产妇选择分娩方式的影响。方法：将嘉兴市妇幼保健院2005年1月-2011年12月间临产后实施硬膜外分娩镇痛的产妇11 250例,按镇痛实施时间不同分为2组：Ⅰ组宫口开至1～3cm（n=8 270）,Ⅱ组宫口开至3cm以上（n=2 980）。分别观察产程时间、手术助产率、新生儿体重和Apgar评分情况,产后24小时随访。结果：各组镇痛效果确切,产程时间、新生儿体重和Apgar评分组间差异无统计学意义（P〉0.05）;产妇对镇痛效果满意,硬膜外镇痛对自然分娩有帮助。结论：低浓度罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛安全、有效,可以在第一产程早期施行,能促进产妇选择自然分娩,从而降低剖宫产率。

Clinical application of patient-controlled epidural analgesia for labor:an analysis of 11 250 parturients

Objective To retrospectively analyze the effects and impacts on the mode of delivery of patient-controlled epidural analgesia using lower concentration ropivacaine with sufentanil at the stage during labor.Methods A total of 11 250 parturients undergoing patient-controlled epidural labor analgesia from January 2005 to December 2011 were divided into two groups according to the time of analgesia initiation.Analgesia was initiated inⅠgroup at cervical dilatation of 1-3 cm(n=8 270),and in Ⅱgroup at cervical dilatation of more than 3 cm(n=2 980).The durations of labor,the rate of instrumental delivery,fetal birth weight and Apgar scores were recorded.A follow-up in 24 hours postpartum was also performed.Results Patient-controlled epidural analgesia provided an effective analgesia in all parturients.There were no significant differences between the two groups in the durations of labor,fetal birth weight and Apgar scores(P>0.05).Maternal satisfaction with labor analgesia was higher.Epidural analgesia improved the vaginal delivery.Conclusion Patient-controlled epidural analgesia using lower concentration ropivacaine with sufentanil provides a safe and effective analgesia for labor,and can initiate early in the first stage labor.It also promotes more parturients to select vaginal delivery and then help to reduce the rate of cesarean delivery.