腰-硬联合自控镇痛分娩对宫缩的影响

The effects on uterine contractions of labor combined Spinal-epidural analgesia

目的探讨腰-硬联合自控镇痛分娩对宫缩的影响,有助于更好指导镇痛分娩处理。方法回顾性分析我院2007年4月至2008年4月采用腰-硬联合自控镇痛法分娩患者312例临床资料,并随机选择同期非镇痛分娩患者69例作对照分析。结果 312例分娩镇痛总有效率100%,发生宫缩乏力252例,发生率80.8%,使用缩宫素252例,宫缩素使用率80.8%,对照组发生宫缩乏力15例,发生率21.7%,使用缩宫素15例,宫缩素使用率21.7%,两组比较(P<0.01),差异有统计学意义;镇痛组例,宫缩乏力发生在第一产程活跃期223例,占88.5%,发生在第二产程29例,占11.5%,对照组宫缩乏力发生在第一产程活跃期6例,占40%,发生在第二产程9例,占60%,两组比较P<0.01,差异有统计学意义。结论腰-硬联合自控镇痛分娩有效镇痛率达100%,但宫缩乏力发生率高,近九成宫缩乏力发生在第一产程活跃期,镇痛分娩过程中应密切监测宫缩情况,发现宫缩乏力时尽早应用缩宫素。

Objective To study the effects on uterine contractions of labor combined Spinal-epidural analgesia,help to better guide the analgesic treatment delivery.Methods A retrospective analysis of our hospital from April 2007 to April 2008 with spinal-epidural patient-controlled analgesia delivery clinical data of 312 patients and randomly selected patients over the same period 69 cases of non-analgesic delivery was calculated.Results 312 cases of analgesia was 100%,252 cases of uterine atony occurs,the incidence of 80.8%,252 cases using oxytocin,uterine prime rate 80.8%,control group,15 cases of uterine atony occurred,occurrence rate of 21.7%,use of oxytocin in 15 cases,utilization rate 21.7%,P0.01,significant difference;Analgesia group cases,uterine inertia occurred in the first stage of 223 cases of active,accounting for 88.5%,occurred in the second stage of labor in 29 cases,11.5%;in the control group produced uterine inertia occurred in the first active stage 6 cases,40%,occurred in the second stage in 9 cases,60%,respectively P0.01,significant difference.Conclusion The combined spinal-epidural analgesia and effective analgesia delivery rate of 100%,but the high incidence of uterine atony,uterine atony nearly 90 percent in the first active phase of labor,during labor,contractions should be closely monitored,oxytocin was used as soon as possible when uterine inertia was found.