分娩镇痛效果不良的相关因素分析

Analysis on related factors of inadequate analgesia in delivery

目的：分析各种因素与分娩镇痛效果不良的相关性，从而为临床医生预测出现镇痛效果不良的可能性提供依据。方法：选择100例待产孕妇，在孕妇宫口开至2～7cm时，取L3／4椎间隙硬膜外穿刺置导管，注入1．0％利多卡因，再连接镇痛泵，泵内药物为0．08％罗哌卡因及芬太尼2．5wg／ml，镇痛泵注药速度为（6～10）ml／hr。给予镇痛首量30min后用VAS评分（0～10分）评估镇痛效果，VAS〉3分的产妇视为镇痛效果不良。记录各项指标：肥胖（BMI〉30）、硬膜外麻醉失败史、孕次、孕周、催产素应用、硬外穿刺时宫口扩张≥7cm、产程时间，麻醉者经验、阻力消失试验采用空气或生理盐水、放置导管不顺畅、局麻药容量、麻醉药物剂量和硬膜外镇痛时间。用，检验进行单因素分析。结果：镇痛效果不良的产妇16人，占总人数的16．7％。单因素分析显示有硬膜外麻醉不成功史、宫颈扩张〉7cm、硬膜外置管不顺畅、产妇肥胖、产程时间、硬外镇痛时间、罗哌卡因的总量与镇痛效果不良有相关性（P〈0．05）。结论：部分产科和麻醉的因素增高了分娩镇痛效果不良的可能性，可通过改善这些因素提高分娩镇痛的成功率。

Objective： To analyze the correlation between a variety of factors and inadequate analgesia in delivery, provide evidence for predicting inadequate analgesia. Methods ： 100 pregnant women delivering vaginally were studied. Epidural catheter was inserted in L3/4 interspace when cervical dilatation 2 -7 cm. 1% lidocain was used for the initial bolus dose, 0. 08% ropivacain combined with 2.5 μg/ml fentanyl were infused continuously at the rate of 6 - 10 ml/hour. 30 minutes after initial bolus, a visual analogue pain score （VAS） was carried out to evaluated the antalgic effect. Inadequate analgesia was defined as VAS ≥ 3 in delivery. A variety of factors were recorded and analysed. Results： 18 pregnant women （ 16. 7% ） were found inadequate analgesia in delivery. Risk factors of inadequate analgesia included： analgesia failure history, cervical dilations〉7 cm, epidural difficult catheterization, obesity, duration of labor, analgesia time, dose of ropivacain （ P 〈 0. 05 ） . Conclusion ： Several obstetrical and epidural - related factors increase the risk of inadequate epidural analgesia.