脊椎-硬膜外联合阻滞应用于妊娠期高血压综合征产妇潜伏期分娩镇痛的临床研究

目的探讨脊椎-硬膜外联合阻滞（CSEA）应用于妊娠期高血压综合征（PIH）产妇潜伏期分娩镇痛的可行性。方法选择经阴道分娩、开始规律宫缩少于10h的轻、中度PIH产妇60例随机分为2组，镇痛组（A组，n=30）于潜伏期（宫口开至0．5～2．5cm）开始实施CSEA分娩镇痛，对照组（B组，n=30）按产科常规处理。记录视觉模拟疼痛评分（VAS），改良的Bromage标准评分，宫缩情况，产程时间，分娩方式，催产素使用情况，新生儿Apgar评分及心率（HR）、血氧饱和度（SpO2）、血压并计算平均动脉压（MAP）。结果A组与镇痛前比较镇痛后各时段的MAP和VAS评分均明显下降（P〈0．05）；A组的剖宫产率及先兆子痫发生率明显低于B组（P〈0．05）。2组运动神经阻滞程度、新生儿相关指标比较差异无统计学意义（P〉0．05）；与B组比较，A组催产素的使用有增高的趋势，但差异无统计学意义（P〉0．05）。结论PIH产妇分娩潜伏期应用CSEA镇痛效果确切，并能降低血压、稳定病情、降低剖宫产率，且不影响新生儿的Apgar评分。

The clinical study on the effect of labor analgesia by combined spinal and epidural anesthesia on parturients with pregnancy induced hypertension at latency

Objective To investigate the feasibility of labor analgesia by combined spinal and epidural anesthesia （CSEA） in application to parturient with pregnancy induced hypertension （PIH） at latency. Methods 60 parturients with mild or moderate PIH whose regular uterine contraction time was less than 10h, were randomly divided into 2 groups, the parturients in analgesia group （ group A, n = 30） were analgecized by CSEA at latency （cervix opening 0.5 -2.5cm）,however, the parturients in control group （group B, n = 30） were handled according to routine treatment in department of obstetrics. The visual analogue pain score （ VAS ） , improved standards Bromage scores were recorded, and uterine contractions, labor time and mode of delivery, using of oxytocin, neonatal Apgar score and heart rate （HR） , blood oxygen saturation （ SpO2 ） , blood pressure and mean arterial pressure （MAP） were measured and observed. Results The MAP and the VAS in group A were significantly decreased after CSEA, as compared with those before CSEA （ P 〈 0. 05 ） ; uterine-incision delivery rate in group A was significantly lower than that in group B （ P 〈 0.05 ） , the incidence of pre-eclampsia in group A was significantly lower than that in group B（ P 〈 0.05 ）. There were no differences in the degree of motor nerve block and neonates related parameters between two groups （ P 〉 0.05）. There was a trend of increase of using of oxytocin in group A, as compared with that in group B, but there was no significant difference between two groups （ P 〉 0.05 ）. Conclusion CSEA at latency of parturient with PIH is effective, which can reduce blood pressure, stabilize the patient＇ s condition, lower cesarean section rate,without effect on the neonatal Apgar score.