3种不同镇痛方法用于产妇分娩的效果比较

目的：探讨产妇自控硬膜外镇痛、笑气吸入镇痛和药物镇痛不同分娩镇痛方法的镇痛效果和对产妇及新生儿的影响。方法：选择120例产妇分为产妇自控硬膜外镇痛组（自控组）、笑气吸入镇痛组（笑气组）、药物镇痛组（药物组）和对照组各30例。自控组于产程活跃期给予硬膜外麻醉,接自控镇痛泵联合注入罗哌卡因和芬太尼;笑气组于活跃期给予吸入含50%氧化亚氮和50%氧气的混合气体;药物组于潜伏期给予度冷丁100mg肌内注射,于活跃期给予地西泮10mg静脉推注;对照组未给予任何镇痛措施。分别观察4组产妇的镇痛效果、产程时间、分娩方式、血氧饱和度及新生儿脐动脉血的血气分析、新生儿窒息情况。结果：在镇痛效果方面,自控组镇痛分级0级为23例,Ⅰ级为5例;笑气组Ⅰ级为15例,Ⅱ级为11例;药物组Ⅰ级为4例,Ⅱ级为20例;对照组Ⅱ级为17例,Ⅲ级为13例;4组比较有显著性差异（P〈0.05）。产程时间、分娩方式、新生儿窒息率、血气分析结果比较均无显著性差异（P〉0.05）。结论：产妇自控硬膜外镇痛用于分娩镇痛效果满意,对产妇及新生儿无明显副作用,可作为分娩镇痛的首选方法;笑气吸入和药物镇痛效果虽仅次于产妇自控硬膜外镇痛组,但方便简单,安全可靠,值得临床推广使用。

Comparison of the effect of three different analgesia on relief of pain in delivery

Objective: To explore the effect of patient controlled epidural analgesia(PCEA),inhalation of nitrous oxide and drug analgesia on relief of pain in delivery and the influence on pregnant women and infants.Methods: One hundred and twenty pregnant women were divided into PCEA analgesia group,nitrous oxide analgesia group,drug analgesia group and control group(30 patients for each).Epidural analgesia was given to pregnant women at the active stage of labor by injecting Fentanyl and Ropivacaine with patient-control instrument in PCEA group;Inhalation of nitrous oxide premixed with oxygen(50%:50%) was given in nitrous oxide analgesia group;Meperidine was injected intramuscularly at latent phase and Diazepam was injected venously at active phase in drug group,and any analgesic was not used in control group.Observation was made on the effective outcome of different analgesia,duration of labor,way of delivery,oxygen saturation of blood,blood gas analysis of umbilical artery of newborn and neonatal asphyxia.Results: Regarding grading of the effective analgesic outcome,grade zero was found in 23 cases and grade I in 5 cases in PCEA group;grade I in 15 cases and grade II in 11 cases in nitrous oxide analgesia group;grade I in 4 cases and grade II in 20 cases in drug analgesia group;grade II in 17 cases and grade III in 13 cases.There was significant difference in the comparison of analgesia among the 4 groups(P<0.05) and no significant difference was found in the comparison of duration of labor,way of delivery,blood gas analysis of umbilical artery of newborn and the rate of neonatal asphyxia(P>0.05).Conclusion: PCEA is one of optimal analgesia on relief of pain in delivery,with less side-effect;it can be taken as the first choice.