自控硬膜外分娩镇痛对产程和母婴预后的影响

目的 研究罗哌卡因联合芬太尼于潜伏期即行硬膜外分娩镇痛的有效性及对母婴预后的影响.方法 回顾性分析2008年1月-2010年12月期间在该院妇产科分娩的1 800例初产妇,其中600例自愿接受罗哌卡因联合芬太尼自控硬膜外镇痛的600例产妇为镇痛组,条件类似却未行镇痛的1 200例为对照组,记录两组产妇的镇痛效果、各产程时间、催产素使用情况、分娩方式、产后出血量、新生儿Apgar评分以及不良反应;测定分娩过程中规律宫缩时（T1）、宫口开全时（T2）、胎儿娩出时（T3）、胎盘娩出后30 min（T4）时的空腹血糖（FPG）、空腹胰岛素（FINS）并计算出胰岛素抵抗指数HOMA-IR.结果 所有产程阶段镇痛组的VAS评分均显著低于对照组;镇痛组潜伏期及活跃期时间均较对照组缩短,第二产程时间较对照组长,差异具有统计学意义（P＜0.05）;两组在第三产程时间以及总产程时间上无明显差异（P＞0.05）;镇痛组阴道分娩率、催产素使用率高于对照组;两组新生儿Apgar评分及胎儿窘迫率无显著差别;镇痛组可以减轻胰岛素抵抗程度和血糖升高程度.结论 罗哌卡因联合芬太尼于潜伏期用于PCEA可降低剖宫产率,提高顺产率,减轻胰岛素抵抗程度和血糖升高程度,且不增加母婴并发症,是一种安全、有效、值得大范围推广的分娩镇痛方法

Effects of patient-controlled epidural analgesia on the labor progress and prognosis of mother and child in delivery

Abstract：Objective To investigate the effects of patient-controlled epidural analgesia （PCEA） with ropivacaine in combination with fentanyl on the labor progress and prognosis of mother and child in delivery. Methods A retrospective study was conducted involving 1 800 healthy primiparas,including 600 primiparas voluntarily undergoing spontaneous labor who were treated with ropivacaine in combination with fentanyl （epidural analgesia group） and 1 200 ones without epidural analgesia （control group）. The analgesic activities, durations of each labor stages, usage of oxytocin, delivery modes, postpartum hemorrhage, Apgar score for neonatus and adverse reactions were recorded;Fasting plasma glucose （FPG） and fasting insulin （FINS） were determined at the time point of regular uterine contraction （ T1 ）, complete dilatation of cervix （ T2 ）, fetal disengagement （ T3 ） and placental expulsion （ T4 ）, then the homeostasis model assessment of insulin resistance in HOMA-IR ] was calculated. Results The VAS scores of all stages of analgesia in epidural analgesia group were significantly lower than those in the control group. The duration of active and latency stages of analgesia group were shorter than the control group, the second stage of labor time was longer than the control group with statistically significant difference （ P 〈 0.05 ）. There were no significant differences in the duration of the third or the total labor stages between the two groups. The ratio of spontaneous labor and usage of oxytocin were higher, and Apgar score of neonatus and the ratio of fetal distress were not increased in the analgesia group. And labor analgesia could reduce the degree of insulin resistance and elevate blood glucose levels. Conclusions PCEA with ropivacaine in combination with fentanyl in the labor progress can decrease the incidence of cesarean section, increase the ratio of spontaneous labor and shorten the duration of the active and latency stages, reduce the degree of insulin resistance and elevate blood glucose levels without increasing the complications of mother and baby. Therefore, PCEA is an effective and safe method which can be used for labor analgesia and is worthy of spreading.