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     

椎管内阻滞麻醉与笑气吸入用于分娩镇痛的效果比较

目的　比较椎管内阻滞麻醉和笑气吸入两种方法的分娩镇痛效果和对产妇及新生儿的影响。方法　随机选取 30 0例产妇分为笑气组、椎管内阻滞组和对照组 ,每组各 10 0例。在分娩过程中 ,笑气组给予吸入含 5 0 %笑气与 5 0 %氧气的混合气体 ;椎管内阻滞组给予蛛网膜下腔 +硬膜外腔联合注入芬太尼和布比卡因 ;对照组未给予镇痛药物。并分别观察 3组产妇的镇痛效果、产程时间、分娩方式、产后出血量、产妇桡动脉血及新生儿脐血的血气分析以及新生儿窒息情况。结果　 (1)镇痛效果比较 :椎管内阻滞组镇痛分级 0级为 88例 ,笑气组为 12例 ,对照组为 0例。 3组之间比较 ,差异有极显著性 (P <0 0 1)。 (2 )产程时间比较 :第一产程和总产程时间 ,椎管内阻滞组短于对照组和笑气组 (P <0 0 5 ) ,笑气组与对照组比较 ,差异无显著性 (P >0 0 5 ) ;第二产程时间椎管内阻滞组长于对照组和笑气组 ,但差异无显著性 (P >0 0 5 )。 (3)剖宫产术后出血量比较 :笑气组为 (373± 77)ml,椎管内阻滞组为 (2 5 9± 78)ml,对照组为 (2 39± 89)ml,笑气组与其他两组比较 ,差异有极显著性 (P<0 0 1)。(4)血气分析结果比较 :3组产妇桡动脉血及新生儿脐血血气分析结果各组之间比较 ,差异均无显著性 (P >0 0 5 )。 (5 )分娩方式比较     

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。     

无痛分娩技术产科临床推广应用

目的探讨无痛分娩技术产科临床推广应用的价值。方法．选取我院2008年至2012年收治的901例产妇为观察组、650例产妇为对照组。对照组采用传统分娩方式处理,并提供导乐服务;观察组给予硬膜外镇痛阻滞处理。观察产妇情况、产程时间、产后出血量、新生儿体重及新生儿评分情况。结果：观察组第一、第二产程时间短于对照组,差异均有统计学意义（P〈O．05）,两组产后失血量及新生儿体重、评分差异无统计学意义（P〉0．05）。结论：无痛分娩技术有利于减轻产妇分娩疼痛,促进产程进展,降低母婴并发症,值得临床推广应用。     

腰硬联合麻醉在无痛分娩中的应用探讨

目的：探讨在无痛分娩的过程中使用腰硬联合麻醉的安全性与效果。方法：将在分娩过程中使用腰硬联合麻醉的无痛分娩200例产妇作为观察组，将在分娩过程中不使用镇痛手段的200例产妇作为对照组。在两组产妇进行分娩时对分娩方式、疼痛情况、Apgar新生儿评分、产程进展的情况、失血量进行观察。结果：观察组在分娩时的有效镇痛率达到100％，比较观察组和对照组发现，观察组的活跃期P值小于0．01，时间明显缩短。观察组和对照组中的两组产妇在产后的出血量、Apgar新生儿评分、分娩的方式等其他因素比较中P值大于0．05，不存在显著的差异。结论：腰硬联合麻醉在无痛分娩过程中安全有效，不会对母婴产生不良影响。     

水中分娩与硬膜外麻醉无痛分娩的临床效果分析

目的比较水中分娩与硬膜外麻醉无痛分娩的临床效果。方法随机抽取80例河北省秦皇岛市妇幼保健院行水中分娩的产妇为水中分娩组,80例行硬膜外麻醉无痛分娩的产妇为无痛分娩组。观察两组产程时间、会阴裂伤、产妇出血量、分娩前后血红蛋白的变化、疼痛程度、住院天数及新生儿情况。结果水中分娩组第一产程及总产程时间较无痛分娩组短,而第二产程及第三产程差异无统计学意义（P〉0.05）;水中分娩组产后2h的出血量略少于无痛分娩组;两组产程时间、会阴裂伤、产妇失血量及产后恢复比较差异有统计学意义（P〈0.05）。结论行硬膜外麻醉分娩镇痛可提供较好的镇痛效果,但却是一种有创操作,对于产妇患有腰部疾病者或对硬膜外麻醉有排斥者则不宜行此法,水中分娩产妇产程时间短,会阴裂伤程度轻,失血量较少,产后恢复快,住院时间短。     

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。     

低浓度布比卡因硬膜外阻滞用于分娩镇痛的临床观察

目的：观察低浓度布卡园硬膜外腔阻滞对分娩的镇痛效应及新生儿的影响。方法：采用0．15％布比卡因腰段持续硬脊膜外腔麻醉。观察镇痛效应、产程、产力、新生儿Apgar评分、分娩方式及失血量。结果：用药组疼痛明显减轻或消失,产妇活动正常,两组官缩、产程、新生儿Apgar评分、血压、失血量均显著差导（,P〉0．05）。结论：低浓度布比卡因硬膜外阻滞用于正常分娩镇痛安全、有效。     

笑气分娩镇痛对产妇及脐血血液流变学的影响

目的:观察笑气镇痛分娩对产妇及脐血血液流变学的影响。方法:随机将临产产妇分成笑气镇痛组(观察组)和非镇痛组(对照组)各30例,观察组宫口开大3cm时吸入50%笑气和50%氧气的混合气体镇痛,对照组则采用心理安慰、宫缩期按摩子宫等方法减轻产痛。观察比较两组产痛程度、产程时间、分娩方式、新生儿Apgar评分等。胎儿娩出后立即分别抽取脐静脉血和产妇末梢静脉血,检测血液流变学。结果:观察组的阵痛强度评分明显低于对照组(P<0·01),笑气镇痛分娩可以明显缩短产程的活跃期和总产程(P<0·05);对产妇血流变各指标无明显影响(P>0·05);可明显降低脐静脉血血流变的各项指标(P<0·01),降低其血液粘稠度。结论:笑气分娩镇痛效果明显并能有效地改善脐静脉血液流变学,从而有利于胎儿血液供应,而且对母体血液流变学无不良影响。     

灭菌水皮下注射联合笑气吸入用于分娩镇痛的临床观察

目的 研究灭菌水皮下注射联合笑气吸入用于分娩镇痛的疗效和对母儿的影响。方法 将住院拟阴道分娩的正常产妇200例，随机分为研究组和对照组各100例。对照组除不给以上镇痛措施外，其他产科处理与研究组相同。比较两组的产痛程度、产程时间、分娩方式、新生儿Apgar评分、产后出血量等。结果 研究组疼痛评分、产程时间、阴道助产率、剖宫产率、新生儿窒息率、产后2h出血量均明显低于对照组（P〈0．05，P〈0．01）。结论 灭菌水皮下注射联合笑气吸入用于分娩镇痛简单、易行、效果满意，且对胎儿无任何不良影响，体现以人为本、人性化的服务宗旨，是一种理想的分娩镇痛方法，值得产科临床推广使用。     

Lachgas als Analgetikum in der Geburtshilfe

Nitrous oxide inhalation has been used for more than 100 years to alleviate maternal pain during childbirth. A positive pharmacological profile and modern flowmeters are making the method a safe and attractive alternative for current mothers-to-be. Using nitrous oxide concentrations of 30–50 % is recommended and pregnant women should be taught to use the method before going into labor in order to achieve the best results.     

全产程多模式分娩镇痛对母婴安全的影响

目的：探讨全产程多模式分娩镇痛对母婴安全的影响。方法：足月、单胎、头位初产妇300例,年龄23～36岁,身高155～172 cm,体质量61～95 kg,孕38～41周,采用随机数字表法将其分为3组：活跃期硬膜外阻滞镇痛组（A组,n=100）、全产程硬膜外阻滞镇痛组（B组,n=100）和经皮神经电刺激（TENS）联合硬膜外阻滞全产程镇痛组（C组,n=100）。记录各组产妇不同时点视觉模拟评分（VAS）、产程时间、产后出血量、催产素使用率及新生儿Apgar评分、脐动脉血血气分析结果;并于临产后（T0）、宫口开全时（T1）取静脉血测β-内啡肽（β-EP）、去甲肾上腺素（NE）、肾上腺素（E）和血糖浓度。结果：B、C 2组产妇潜伏期（宫口≤3 cm）各时点VAS评分低于A组,差异有统计学意义（均P＜0.05）。A、C 2组产妇第一产程时间和催产素使用率均低于B组,差异有统计学意义（均P＜0.05）。3组新生儿Apgar评分和脐动脉血血气结果比较,差异无统计学意义（均P＞0.05）。与T0时比较,3组产妇T1时血β-EP、NE、E和血糖浓度均升高,差异有统计学意义（均P＜0.05）。C组产妇T1时β-EP浓度较A、B 2组升高,B、C 2组 NE、E和血糖浓度较A组降低,差异有统计学意义（均P＜0.05）。结论：全产程多模式分娩镇痛在保证产妇镇痛效果的基础上,降低了催产素使用率且不影响产程及围生儿结局,对母婴安全起到保护作用。     

Traditional analgesic agents: are parenteral narcotics passé and do inhalational agents still have a place in labour?

Systemic labour pain treatment with opioids and inhaled nitrous oxide has for many decades frequently been used in medically developed countries. Self-administered nitrous oxide (50% in oxygen) has never gained the same popularity in the USA as in the UK or Scandinavia but the use of opioids, mainly pethidine, has generally been widespread in spite of well-known negative effects on the postnatal adaptation of the newborn. Since the often very intense labour pain seems to respond very poorly even to highly sedating doses of parenteral opioids, their frequent use during delivery and parturition has to be questioned. Self-administered inhalation of nitrous oxide 50% in oxygen also has a limited efficacy for relieving labour pain but because it is mainly devoid of adverse effects on the baby or on the parturient its future use in obstetrics can be defended more easily, either as a sole agent in women with low labour pain scores or in early labour preceding epidural analgesia.     

Effect of stress during labor on the concentration of cortisol and estriol in maternal plasma.

The effect of stress during labor on the plasma concentration of cortisol, unconjugated estriol, and human chorionic somatomammotropin was studied in 15 healthy primiparous women. According to the method of pain relief the parturients were divided into two groups. One group was given continuous epidural analgesia and the other group received pethidine, diazepam, and nitrous oxide/oxygen in response to pain. In the most stressed nonepidural group there was a significant rise in the cortisol level during labor and the estriol concentration fell significantly. In the epidural group no significant changes were observed with respect to the concentration of either cortisol or estriol. These results give further support to the hypothesis that severe maternal stress may lead to a reduced concentration of estriol in maternal plasma.     

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.     

Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor.

OBJECTIVES: To compare analgesic efficacy of intramuscular opioids: meperidine and tramadol with epidural analgesia. METHODS: One hundred and twenty-eight term nulliparous women with singleton pregnancy and vertex presentation were randomized to receive either epidural (n=43), meperidine (n=39) or tramadol (n=44). A visual analog scale (VAS) was used to assess the severity of pain. The parameters analyzed were analgesic efficacy, effect on labor, other maternal side effects, perinatal outcome and maternal satisfaction. RESULTS: Median VAS scores following first dose were 0 (0-5), 5 (3-8) and 5 (3-8) in epidural, meperidine and tramadol groups, respectively. Ninety percent of women rated analgesia as good to excellent in the epidural group as compared with 72% of women in the meperidine group and 65% in tramadol group. However, epidural caused a significant prolongation of first (P<0.05) and second (P<0.01) stage of labor with an increased number of operative deliveries (27% in the epidural, 7.6% in the meperidine, and 11.4% in the tramadol groups, P<0.05). In the epidural group 40% women had urinary retention and 16% had motor weakness, whereas sedation was the only side effect seen in the meperidine (41%) and tramadol groups (9%). Respiratory depression was noted among three neonates in the meperidine group, two in the tramadol group and none in the epidural group. CONCLUSIONS: The analgesic efficacy and maternal satisfaction is better with epidural analgesia than with opioids. Analgesia provided by meperidine and tramadol is comparable and approximately 50% of women rated the analgesia as good. Meperidine is better in the second stage than tramadol. Hence in developing nations where availability of facilities is the main limiting factor, intramuscular opioids can be considered suitable alternatives.