导乐联合硬膜外阻滞无痛分娩142例效果观察及护理

Observation on the effect of combined application of Doula delivery and epidural anesthesia on painless labor in 142 cares and nursing care

目的:探讨导乐联合硬膜外阻滞无痛分娩的镇痛效果与护理方法。方法:将284例产妇随机分为实验组和对照组各142例,实验组采用导乐联合硬膜外阻滞无痛分娩,对照组采用单纯硬膜外阻滞无痛分娩,对两组镇痛效果、并发症、PCA泵实时记录、产程时间、分娩方式、产后出血量及镇痛方法对胎儿、新生儿的影响进行分析比较。结果:两组镇痛效果及并发症发生率比较无显著性差异(P>0.05);实验组平均进药总量、按压次数与实际有效进药次数比值均显著低于对照组(P<0.01);实验组第一产程活跃期及第二产程均显著短于对照组(P<0.01),阴道手术助产率也显著低于对照组(P<0.01);两组胎儿窒息及新生儿窘迫发生率比较无显著性差异(P>0.05)。结论:导乐联合硬膜外阻滞用于无痛分娩,镇痛效果良好,对母婴无不良影响,减少了麻醉药物的用量,减轻了运动神经阻滞对产力的影响,缩短了第一产程活跃期及第二产程,降低了阴道助产率,充分保障了母婴安全,值得推广应用。

Objective ： To explore the effect of combined application of Doula delivery and epidural anesthesia on analgesia delivery. Methods： Two hundred and eighty four pregnant women were randomly divided into experiment group （n=142） and control group （n=142）. Doula delivery was applied in combination with epidural anesthesia in experiment group and epidural anesthesia was simply used in control group, and the comparison and analysis were made in the effect of analgesia, complication, records of real-time of PCA, duration of delivery, delivery mode, postpartum hemorrhage and the af- fecting of analgesia to fetus and newborn. Results ： There was no significant difference in the comparison of the effect of an- algesia and the incidence of complication between the two groups （P〉0.05）; the average amount of anesthetic, times of press and the real times of administering anesthetic effectively were less in experiment group than that in control group （P〈0.01） ; the active phase of the first stage of labor and the second stage of labor was evidently shorter in experiment group than that in control group （P〈0.01）; the rate of vaginal operation in assistance of delivery was lower in experiment group than that in control group; no significant difference was found in the comparison of fetal asphyxia and neonatal distress be-tween the two groups （P〉0.05）. Conclusion： Combined application of Doula delivery and epidural anesthesia is very effective in analgesia delivery, which has no side effect on lying-in women and newborn and can shorten the active phase of the first stage of labor and the second stage of labor and reduce the rate of vaginal operation in assistance of delivery.