不同时机行硬膜外分娩镇痛对母婴的影响

目的研究不同时机行硬膜外分娩镇痛对母婴的影响。方法选择第一胎的足月初产妇,随机分为A、B、C、D 4组。A组为对照组,按产科常规处理。B组为宫口开至<1 cm行硬膜外自控镇痛。C组为宫口开至1~3 cm行硬膜外自控镇痛。D组为宫口开至3~5 cm行硬膜外自控镇痛。观察并记录镇痛效果(VAS)、下肢运动阻滞程度、产程时间、分娩方式、催产素的使用情况及新生儿Apgar评分。结果B、C、D组镇痛效果良好,各组静脉滴注催产素加强宫缩例数较A组多,均有显著性差异(P均<0.05)。B、C组潜伏期明显短于A组(P均<0.05),B组短于C组(P<0.05),活跃期只有B组短于A组(P<0.05);第二产程时间D组长于A组(P<0.05);第三产程时间各组均无显著性差异(P均>0.05)。B、C、D各组阴道自然分娩率和剖宫产率与A比较有显著性差异(P均<0.05)。产钳助产率、新生儿Apgar评分等情况与A组比较,无显著性差异(P>0.05)。B组产妇的总体满意度高于C、D 2组。结论第一产程早期行硬膜外自控镇痛效果确切,缩短产程,不影响新生儿,不增加剖宫产率,可以提高产妇的满意度。

The influences of epidural analgesia with different starting times to mothers and neonates in delivery

Objective It is to observe the influences of epidural analgesia with different starting times to mothers and neonates in delivery.Methods 120 cases of full term primipara were divided into 4 groups.Group A was control group,in which obstetric routine management was given to the primipara.In group B,patient controlled epidural analgesia was given when the uterine cervix dilated to no more than 1 cm.Patient controlled epidural analgesia was given when the uterine cervix dilated to 1～3 cm in group C.And in group D,patient controlled epidural analgesia was given with a cervical dilatation of 3～5 cm.Analgesia effects(VAS),motor nerve blocking degrees of lower limbs(assessed by modified Bromage scale),duration of labor,delivery mode,usage of Oxytocin and neonatal Apgar scores were observed and recorded.Results Good analgesia effects were observed in group B, C and D.More cases received Oxytocin by intravenous infusion to strengthen uterine contraction in group B,C and D than in group A,with significant differences(P<0.05).Latent stage of group B and C was significantly shorter than group A(P<0.05).Latent stage was shorter in group B than in group C(P<0.05).Active phase of group B was shorter than group A(P<0.05).Second stage of labor was longer in group D than in group A(P<0.05). Third stage of labor showed no significant difference amonga all groups(P>0.05).Rate of vaginal spontaneous labor and cesarean section in group B,C and D showed significant difference with group A(P<0.05).Forceps delivery rate and neonatal Apgar scores showed no significant difference between the 3 groups and group A(P>0.05).Satisfaction degree of parturients in group B were higher than group C and D.Conclusion Patient controlled epidural analgesia be given early in the first stage of labor can produce exact analgesia effects,shorten duration of labor,without influences of neonates,without increasing of cesarean section rate,and can increase the satisfaction degree of parturient.