产前抗焦虑干预对镇痛分娩效果的影响

目的 探讨产前抗焦虑干预对产时镇痛分娩效果的影响.方法 选择80例足月、单胎、头位、无产科合并症和精神疾病史,在本院例行产检和分娩的初产妇.所有产妇于住院前孕32～ 36周在产前门诊用焦虑自评量表（SAS）法进行焦虑评分,且SAS≥50分.根据是否参加在本院进行镇痛分娩知识培训干预分为两组（每组40例）：培训组（T组）和非培训组（N组）.两组产妇入院后镇痛前和胎儿娩出后24h同样进行SAS焦虑评分.两组镇痛模式相同,于宫口扩张至2～4 cm时行分娩镇痛,经L2～3行脊椎-硬膜外穿刺成功后,蛛网膜下腔注射舒芬太尼7.5μg,硬膜外置管,接硬膜外自控镇痛（PCEA）装置,以0.1％罗哌卡因配伍0.5 μg/ml舒芬太尼的混合液100 ml行硬膜外镇痛,设定单次剂量6ml,锁定时间15 min,无背景剂量.记录不同时点SAS焦虑评分、产程中疼痛程度的级别、镇痛总时间、PCEA实际按压次数、PCEA有效按压次数、用药总量,由于镇痛不全求助医务人员的总次数；记录分娩方式、新生儿Apgar评分及产妇对镇痛满意度.结果 SAS焦虑评分入院后镇痛前、分娩后24 hT组明显低于N组（P＜0.01）,与入院前比较,T组显著降低（P＜0.01）,而入院前两组无统计学差异（P＞0.05）；分娩前后,T组较N组疼痛程度明显减轻（P＜0.01）；PCEA实际按压次数、PCEA有效按压次数、用药总量、由于疼痛不适求助医务人员的总次数T组显著低于N组（P＜0.01）；镇痛满意度T组较N组明显增高（P＜0.01）；两组分娩方式和新生儿Apgar评分差异无统计学意义（P＞0.05）.结论 产前抗焦虑干预可以减轻产妇住院分娩期间的焦虑程度,提高镇痛效应和满意度,减少镇痛药物的需要量和因疼痛求助医务人员的次数.

Influence of antenatal antianxiety intervention on analgesia labor

Objective To investigate the antianxiety intervention effect on analgesia during labor.Methods A total of 80 parturients,all nulliparous,and classified as ASA I-Ⅱ in spontaneous labor with singleton,vertex,full-term fetuses,no obstetric complications and mental illness were randomly assigned to two groups：Group T with training and Group N without training.Anxiety scores in different time,the degree of pain during the laboring,the total analgesia time,the effective push times of PCA,the total dose,the delivery mode,neonatal Apgar score and parturients satisfaction of analgesia and the total times of asking the medical staff for help were observed and compared.Results The degree of anxiety before analgesia and 24 h after childbirth in group T were significantly lower than group N （P ＜ 0.01）.The effective push times of PCA,the total dose,and the total times of asking the medical staff for help in group T was lower than group N （P ＜ 0.01）.The analgesia satisfaction in group T was higher than group N（P ＜ 0.01）.The delivery mode and the neonatal Apgar score had no statistical significance（P ＞ 0.05）.Conclusion Antenatal interventions can reduce maternal anxiety,analgesic requirements and pain,antenatal interventions can improve analgesia effect and satisfaction.