异氟醚吸入分娩镇痛效果及对母儿的影响

目的 :探讨异氟醚吸入分娩镇痛的效果及其对母儿的影响。方法 :75例产妇随机分为 3组 ,每组 2 5例 ,于分娩活跃期分别吸入体积分数为 0 2 0 %～ 0 75 %异氟醚 (A组 ) ,体积分数为 30 %～ 5 0 %笑气 (B组 )和空气 (C组 ) ,用视觉模拟 (VAS)评分观察镇痛效果 ,记录各产程时间 ,分娩方式及产后出血量以及胎心率的变化 ,羊水粪染率 ,Apgar评分及脐血血气分析。A、C组分别于用药前及分娩后取母静脉血和脐血测定血清中氟离子浓度 ,及对肝肾功能的影响。结果 :A组疼痛分数明显下降 ,低于B ,C组 (P <0 0 5 ) ;宫缩应激试验 (CST)评分 ,羊水粪染率 ,Apgar评分 ,分娩各产程时间 ,分娩方式及产后出血量 3组比较差异无显著性 (P >0 0 5 ) ;3组脐动、静脉血气分析结果均在正常范围 ,组间差异无显著性 (P >0 0 5 )。A组分娩后母血氟离子浓度与用药前及C组比较 ,无明显增高 (P >0 0 5 ) ;脐血氟离子浓度平均为 (4 47± 1 2 1) μmol L ,与C组比较差异无显著性 ,远达不到毒性阈值。分娩后A、C组肝、肾功能均无异常。结论 :吸入异氟醚分娩镇痛效果显著 ,优于吸入笑气镇痛 ,对母体胎儿及新生儿状况无不良影响。

Effect of inhaling isoflurane for analgesia in labor

To study the efficiency of inhalating isoflurane for vaginaldelivery and its influence on mothers and infants. Methods: Seventy five primiparae were divided randomly and eqnally into three groups: Group A received 0.2% to 0.75 % isoflurane and oxygen; Group B received 30% to 50% nitrous oxide and oxygen and Group C received air. The efficiency of inhalation analgesia was evaluated by visual analog scale(VAS). Status of fetus and neonate were evaluated by fetal heart rate(FHR),nature of amniotic fluid at birth and Apgar scores. The time of each labor stage, mode of delivery and postpartum hemorrhage were record-ed. Blood gas data of umbilical artery and vein were analyzed. Serum inorganic fluoride concentrations of the mothers in Group A,C were analyzed before analgesic and after delivery and that in umbilical cord blood. Biochemical liver and renal function were examed after delivery. Results: Mean VAS pain scores of Group A was significantly lower than that of Group B and C. ( P <0.05)There were no significant differences in the rates of meconitum stained,abnormal FHR and Apgar score; The time of each stage of labor, mede of delivery and mean hemorrhage volumn did not indicate any differences among the three groups( P > 0.05).Acidbase balance and blood gas data of umbilical artery and vein were good in there groups, and there were no significant differences.(P>0.05). Serum inorganic fluoride concentrations in the mother of Group A after anesthesia were not significantly increased compared with preanesthetic levels and that of Group C. The mean unbilical cord concentration of scrum inorganic fluoride in Group A was (4.47+1.21)tμmol/L, and there was no significant difference compared with Group C, a value well below that assoiated with nephrotoxicity. There were no biochemical evidence of renal and liver toxicity. Conclusion: The inhalation of isoflurane mayachieve an excellent pain relief which is better than nitrous oxide and has no adverse effects on maternal and neonatal status duringnormal labor.