不同时机开始使用腰麻硬膜外联合阻滞麻醉分娩镇痛的临床观察

The different opportunity to use CSEA

目的探讨腰麻硬膜外联合阻滞麻醉分娩镇痛（CSEA）的时机选择及其对母婴的影响。方法 170例初产妇,其中宫口开大1~2cm时使用CSEA的46例为A组,宫口开大3~4cm时使用CSEA的64例为B组,同时期分娩的60例未使用CSEA的初产妇为对照组;比较三组孕妇的产程、分娩方式、新生儿脐动脉血乳酸和血气情况。结果与对照组比较,A组和B组第一、二产程时间无明显延长（P〉0.05）,A组和B组剖宫产率明显降低（P〈0.05）,A组和B组新生儿脐静脉血乳酸明显减低（P〈0.05）。结论提早分娩镇痛的时间对产程、孕妇及新生儿无明显不良影响并可降低剖宫产率。

Objective To study the best time to use CSEA and its effect on both mothers and newborns.Methods 170 nulliparous parturients were enrolled into this study,in which CSEA was used to 46 cases at a cervical dilatation of 1~2 cm（A group）;CSEA was used to 64 cases at a cervical dilatation of 3~4 cm（B group）;the other 60 nulliparous parturients without CSEA were randomly selected as controls.The labor delivery mode,postpartum hemorrhage of nulliparous parturients and umbilical artery blood lactate of newborns were observed and compared with the control group.Results To compare with the control group,the active stage and the second labor stage of the study group were not significantly longer;the cesarean section rate of the study group was significantly lower（P0.05）;the A and B groups＇ umbilical artery blood lactate of newborns were significantly reduced（P0.05）.Conclusion CSEA used in advance can reduce cesarean section rate,with no side effect on labor,mothers and newborns.