硬膜外分娩镇痛对分娩方式的影响

目的 评价硬膜外分娩镇痛对分娩方式的影响.方法 初产妇400例,ASA Ⅰ或Ⅱ级,足月、单胎、头位,无妊娠并发症及硬膜外麻醉禁忌证.分为硬膜外镇痛组和非镇痛组(n=200).硬膜外镇痛组宫口开至3 cm时,采用0.1%罗哌卡因混合0.5 μg/ml舒芬太尼行硬膜外镇痛,宫口开全后停止镇痛.记录镇痛前和镇痛15 min时VAS评分;评价运动阻滞程度;记录分娩方式、第一产程、第二产程、新生儿出生后1、5 min时Apgar评分和新生儿体重;记录镇痛过程中不良反应的发生情况.结果 硬膜外镇痛组镇痛15 min时VAS评分由(8.3±0.8)分降至(1.6±1.1)分(P＜0.05).与非镇痛组比较,硬膜外镇痛组顺产率和阴道器械助产率升高,剖宫产率降低,第一产程和第二产程延长(P＜0.05).2组新生儿出生后1、5 min时Apgar评分和新生儿体重比较差异无统计学意义(P＜0.05).硬膜外镇痛组下肢运动阻滞发生率为0.5%,下肢麻木发生率为9.0%,恶心呕吐发生率为1.5%.结论 硬膜外分娩镇痛可降低剖宫产率,提高自然分娩率.

Effects of epidural analgesia for labour on mode of delivery

Objective To evaluate the effects of epidural analgesia for labour on mode of delivery.Methods Two-hundred ASA I or II nulliparons psrturients who were at full term with a singleton fetus in vertex presentation without obstetric complications and contraindications to epidural anesthesia and waiting for vaginal delivery received epidural analgesia for labour.Another 200 comparable nulliperous parturients who did not receive epidural labour analgesia were used as control.The epidurai catheter was placed at L2-3 interspace when their cervical dilation was 3 cm in analgesia group.A mixture of 0.1% ropivacaine and sufentanil 0.5 μg/ml was used for patient controlled epidural analgesia (PCEA).After a loading dose of 12-15 ml,the catheter was connected to a PCA pump progrannned to deliver 1 ml with a lockout interval of 15 rain and background infusion at 5 ml/h.PCEA wasstopped at complete corvical dilatation.The intensity of labour pain,the mode of delivery,the length of labour and the Apgar score of the newborn at 1 and 5 min after birth were recorded in both groups.The degree of motor block,lower extremity numbness and the incidence of adverse reactions such as hypotension,nausea,vomiting and pruritus were recorded in the analgesia group.Pain was measured using VAS score (0=no pain,10=worst pain).Motor block was measured by Bmmage score.Results The two groups were comparable with respect to age,body weight,height,gestation weeks and VAS score before analgesia.VAS score was reduced from 8.3±0.8 before analgesia to 1.6+1.1 after the loading dose in the analgesia group.The rates of spontaneous vaginal delivery and instrumental vaginal delivery were significantly higher and 'the rate of caesarean section was significantly lower in the analgesia group than in the non-analgesia group.The 1st and 2nd stages of labour were significsutly longer in analgesia group than the control group.There was no significant difference in Apgar scores at 1 and 5 min after birth between the 2 groups.0.5% of the patients in the analgesia group exhibited signs of motor block (Bromage score≥1 ).The incidence of numbness in lower limbs was 9.0% and of nausea and vomiting was 1.5%.No parturient developed hypotension and pruritis.Conclusion Epidural labour analgesia can decrease the rate of caesarean section,increase the rate of spontaneous vaginal delivery.