腰麻联合双管硬膜外分娩镇痛的临床效果

目的评估腰麻联合双管硬膜外分娩镇痛的效果及对母婴的影响。方法 2015年4月至2016年1月于本院要求分娩镇痛的初产妇129例,随机分为两组。D组(n=68)腰麻后双管硬膜外阻滞分娩镇痛,S组(n=61)腰麻后单管硬膜外阻滞分娩镇痛。记录镇痛前(T0)及镇痛后10min(T1)、30 min(T2)、120 min(T3)、宫口开至7~8 cm(T4)、宫口开全(T5)、第二产程用力分娩时(T6)的VAS疼痛评分,各产程时间及缩宫素使用情况,镇痛泵按压及镇痛药物使用情况,分娩方式,产时出血量,新生儿情况和镇痛不良反应。结果 T0~T4时两组VAS评分差异无统计学意义,T5、T6时D组VAS评分明显低于S组(P0.05)。镇痛泵有效按压次数及镇痛药物使用量两组差异无统计学意义,但镇痛泵总按压次数D组明显少于S组(P0.05)。各产程时间、缩宫素使用率、分娩方式、产时出血量、新生儿情况和镇痛不良反应两组差异均无统计学意义。结论腰麻联合双管硬膜外分娩镇痛效果确切,不良反应少,产妇满意度高,对母婴是安全的。

Clinical effect of spinal anesthesia combined with double-catheter epidural for labor analgesia

Objective To study the analgesia effect of spinal anesthesia combined with double-catheter epidural for labor analgesia and its influence on mothers and fetuses.Methods One hundred and twenty-nine primiparas from April 20 1 5 to January 20 1 6 in our hospital,who requested labor anal-gesia,were randomly divided into two groups:Group D(n = 68 )was treated with spinal anesthesia combined with double-catheter epidural block for labor analgesia;Group S(n =6 1)was treated with spi-nal anesthesia combined with single-catheter epidural block for labor analgesia.Maternal visual analogue scale (VAS)was monitored before(T0 )and 1 0(T1 ),30(T2 ),1 20(T3 )min after analgesia,at the time points with a 7-8 cm cervical dilatation (T4 ),full cervical dilatation(T5 )and the second stage of labor force delivery (T6 ).The duration of different stages of labor,the usage of oxytocin,the usage of anal-gesia pump and analgesics,delivery outcome,volume of bleeding,the neonate condition as well as the side effects of analgesia were all recorded.Results VAS scores of T0-T4 between the two groups had no significant difference,VAS scores of T5-T6 ,group D was less than that of group S (P <0.05).Anal-gesia pump and analgesics usage between the two groups had no significant difference,analgesia pump usage of group D was less than that of group S (P <0.05).There was no significant difference between the two groups in the duration of different stages of labor,oxytocin usage,delivery outcome,volume of bleeding,the neonate condition as well as the side effects of analgesia.Conclusion The spinal anesthesia combined with double-catheter epidural block is effective for labor analgesia,with less side-effects and higher satisfaction of primiparas.it is safe for mothers and fetuses.