早期全程患者自控硬膜外镇痛对胎儿及新生儿的影响

The impact of early whole course patient controlled epidural analgesia on the fetus and neonate

目的：分娩镇痛的方法很多,但在镇痛时机的选择上仍存在分歧,目前的镇痛方法大多推荐宫口开至3~4cm后才给予镇痛。文中探讨早期全程患者自控硬膜外镇痛（PCEA）对胎儿及新生儿的影响。方法：选择单胎、头位、孕周≥37周、要求分娩镇痛的初产妇180例,随机分为3组,每组60例。全程镇痛组从临产开始镇痛,第2产程持续直至分娩结束;第1产程镇痛组从临产开始镇痛,在宫口开全后关闭镇痛泵;对照组为非镇痛的初产妇。记录3组产程中胎儿心率、胎心监护变化、新生儿羊水的性状及Apgar分数、胎儿脐带静脉和动脉血气分析。结果：镇痛组剖宫产率为20.87%,显著低于对照组（43.33%）,P〈0.05。3组产钳使用率差异无统计学意义（P〉0.05）。在镇痛过程中,3组胎心率异常、胎心监护、羊水性状异常、新生儿Apgar评分的差异无统计学意义（P〉0.05）,而产后脐带动静脉血气分析中,3组的HCO3-和碱剩余（BE）值差异有显著性统计学意义（P〈0.05）。结论：早期全程持续的PCEA不会增加胎儿宫内窘迫及新生儿窒息的发生率。

Objective： There are many ways of labor analgesia, but differences still exist regarding the timing of analgesia, most analgesiologist recommended analgesia when cervical dilatation reaches 3 - 4 cm. The present study explored the impact of early whole course patient controlled epidural analgesia （PCEA） on neonates . Methods： One hundred and eighty nulliparous women with term cephalic singleton pregnancies requesting epidural analgesia were enrolled. They were randomly divided into three groups, throughout analgesia Group （ n = 60） ： Analgesia was started and continued to the end of the second stage of labor. First stage of labor analgesia Group （ n = 60 ） ： Analgesia was given until the second stage of labor. Sixty nullipara were selected to the non-analgesia group as control. Fetal heart rate, mode of delivery, characters of amniotic fluid, neonatal Apgac scores, umbilical vein and blood gas analysis were monitored and recorded. Results： The rate of cesarean section in the analgesia group was 20.87%, which was significantly lower than the non-analgesia group （43.33 % , P 〈 0.05 ）, the frequency of utilization of forceps was not significant statistically in the three groups （ P 〉 0. 05 ）. The abnormality of fetal heart rate and fetal heart rate monitoring, the characters of amniotic fluid and neonatal Apgar score were not different statistically in the three groups （ P 〉 0.05 ）, while the difference of dynamic HCO3-, BE in the umbilical blood gas analysis was significant statistically in the three groups （P 〈0. 05）. Conclusion： The early whole course patient controlled epidural analgesia did not increase the incidence of fetal distress and neonatal asphyxia.