腰硬联合阻滞后硬膜外自控镇痛在分娩镇痛中的应用

The application of combined spinal-epidural analgesia and patient-control epidural analgesia in painless labor

目的：探讨腰硬联合阻滞后硬膜外自控镇痛（CSEA＋PCEA）对分娩方式的影响。方法：将60例A SAⅠ-Ⅱ级单胎头位、无明显头盆不称、自愿接受分娩镇痛的足月初产妇随机分为两组：镇痛组（A组）和对照组（B组）。A组（n=30）待宫口开至2-3 cm时行L2-3间隙穿刺,向蛛网膜下隙注入0.2%舒芬太尼3-5μg（1.75 mL）,硬膜外腔头向置管4 cm,10 m in后连接硬膜外自控镇痛泵,PCEA输注0.1%罗哌卡因与舒芬太尼1.5μg/mL,单次剂量4 mL,锁定时间15 m in,背景剂量4 mL/h。B组（n=30）常规分娩处理,未实施分娩镇痛。观察镇痛效果、运动神经阻滞情况、产程进展及分娩方式、新生儿出生后A pgar评分情况及不良反应。结果：两组镇痛效果比较差异有统计学意义（P〈0.01）;两组活跃期和第二产程时间比较差异有统计学意义（P〈0.05）;两组缩宫素使用量及剖宫产率差异有统计学意义（P〈0.05）;两组新生儿出生后1,5 m in的A pgar评分无统计学意义。结论：CSEA＋PCEA镇痛效果明显,无运动阻滞,不良反应较少,对产程有一定抑制,但对分娩结局无明显影响。

Objective：To study the effects of combined spinalepidural analgesia（CSEA） and patient-control epidural analgesia on mode of delivery.Methods：Sixty ASA Ⅰ～Ⅱ full term primigravidain active labor who had a single fetus with vertex presentation and were expected to have a vaginal delivery were randomly divided into 2 groups：analgesia group（A） received CSEA＋PCEA with ropivacaine and sufentanyl（n=30）,Control group（B） received no analgesia（n=30）;In group A CSEA was performed at L2～3 at 2～3 cm cervical dilation.0.2% sufentanyl 3～5 μg were injected intrathecally.A catheter was then advanced 4 cm into epidural space cephalad for PCEA with a mixture of 0.1% ropivacaine with sufentanyl 1.5 μg/mL（background infusion 4 mL/h,demand bolus 4 mL with a 15 min lockout interval）.In group B patients was normal delivery with no analgesia.The intensity of pain,the retardant situation of nervus,the progress of labor,the way of delivery and the score of Apgar after birth was observed and recorded.Results：Statistical difference was found between the two groups in the effect of analgesia（P0.01）.The duration of active phase in the first stage and the second stage in the study group were significantly longer than that of control group（P0.05）.The difference of Apgar score of newborn after 1,5 min has no statistically significant.Conclusion：CSEA＋PCEA has positive effect on labor analgesia and result in no motor block and little adverse feedbacks.Although it has adverse effect on labor progress,delivery consequence can not be affected apparently.