自控硬膜外分娩镇痛监护模式改良的临床研究

Study on monitoring of self-control epidural analgesia in delivery

目的探讨非麻醉医师全程监护硬膜外分娩镇痛的安全性及可行性。方法选取自愿要求分娩镇痛的单胎头位初产妇324例,随机分为A组和B组,每组162例。两组宫口开大3cm行硬膜外穿刺,按硬膜外分娩镇痛需求使用局麻药和阿片类药物,并连接PCA泵。A组麻醉医师监护30min,镇痛效果满意,生命体征平稳,交由一名陪伴助产士协助进行后续的母婴监护,如有异常情况即通知麻醉医师处理;B组由麻醉医师全程监护守候直至分娩结束。并与同期未行分娩镇痛的单胎头位初产妇298例进行对照(C组)。结果 324例实施自控式硬膜外分娩镇痛的产妇,90.7%镇痛效果满意,有2例发生低血压,1例出现轻度头痛症状(均发生在穿刺用药后10min内),经左侧卧位给氧输液处理迅速缓解,无其它硬膜外穿刺副反应及麻醉不良反应发生,母婴监护正常。结论自控式硬膜外分娩镇痛中,训练有素的专职助产士协助麻醉师进行后续的麻醉监护是安全可行的。

Objective To explore safety and feasibility of self-control analgesia under monitoring of non-anesthetist in child delivery.Methods 324 volunteering single head birth primiparae were randomly divided into Group A and Group B with 162 at each. When patients’ orifice of uterus opened to 3cm, local anesthetic and opioid were administered with connection to a PCA pump for epidural anesthesia in the two groups.In Group A,monitoring of anesthesia was transferred from anesthetist to a midwife when satisfied anesthetic result was received 30 minutes later. Any abnormal conditions will be reported to anesthetist immediately for management. In Group B, anesthetist monitored whole course of delivery.298 single head birth primiparae without epidural analgesia at the corresponding period were taken as control group （Group C）.Results Among the 324 women conducted self-control epidural analgesia, 90.7% received satisfied anesthetic results. 2 women emerged low blood pressure and 1 complained mild headache within 10 minutes after administering anesthetic.Symptoms relieved after patients taking a lateral recumbent position and giving oxygen therapy. There were no other side effects and anesthetic reactions occurred.Conclusion Trained midwife can assist anesthetist to conduct anesthetic monitor in self-control epidural analgesia in child delivery.