不同时机硬膜外分娩镇痛对产程及母婴的影响

Effect of patient controlled epidural analgesia at different laboring phases on the progress of labor and neonatal outcomes

目的研究不同时机行硬膜外自控分娩镇痛对产程及母婴的影响。方法选择头胎的足月初产妇200例，随机均分为Ⅰ、Ⅱ、Ⅲ组和对照组（IV组）。Ⅰ组在宫口开至3～5cm时行分娩镇痛，Ⅱ、Ⅲ组在宫口开至1cm时行分娩镇痛，Ⅰ、Ⅱ组宫口开全停止镇痛，Ⅲ组宫口开至8em时停止镇痛。Ⅳ组为对照组，按产科常规处理。观察并记录各产程持续时间；记录宫口开至1cm（T0）、3cm（T1）、8cm（T2）、宫口开全时（T3）、胎儿娩出时（T4）的镇痛评分（VAS评分）；记录分娩方式、缩宫素的使用情况；记录新生儿1、5minApgar评分、脐动脉血血气分析及新生儿神经行为（NBNA）1～3d的评分。结果第一产程潜伏期Ⅱ、Ⅲ组明显短于Ⅰ、Ⅳ组（P〈0．01），活跃期Ⅰ、Ⅱ、Ⅲ组短于Ⅳ组（P〈0．05），第二产程时间Ⅲ组短于Ⅰ、Ⅱ组（P〈0．05）；Ⅱ、Ⅲ组产妇的VAS评分明显低于Ⅳ组（P〈0．05）；Ⅲ、Ⅳ组产钳助产率明显低于Ⅰ、Ⅱ组（P〈0．05）；四组新生儿1、5minApgar评分、脐动脉血血气分析的各项指标差异均无统计学意义；新生儿出生后第1天NBNA评分（NBNA1评分）Ⅲ组明显高于Ⅰ、Ⅱ、Ⅳ组（P〈O．05）。结论潜伏期行硬膜外分娩镇痛效果确切，可缩短产程；宫口开至8cm时提前停止镇痛，可提高母婴的安全性。

Objective To observe the influence of epidural analgesia at different phases of labor on progress of labor and neonates in delivery. Methods Two hundreds cases of full term primipara were divided into 4 groups. In groupⅠ, analgesia was given with acervical dilatation of 3-5cm. In groupⅡ and group Ⅲ, analgesia was given when the uterine cervix dilated to no more than 1 cm Analgesia stopped in group when the uterine cervix dilated to 8 cm. In grouplor groupⅡ, analgesia stopped when the uterine cervix dilated absolutely. Group Ⅳ, the control, was in such obstetric routine management. Pain was assessed using visual analog scale （VAS）. Duration of labor, delivery mode, and usage of oxytocin were observed and recorded. Then the following were recorded, the umbilical arterial samples of the infants, Apgar score of neonates in 1 or 5 rain and neonatal behavioraLneurological assessments （NBNA） of 1-3 days. Results Latent stage of group ]] or group ]I[ was significantly shorter than that of group Ⅰ or group Ⅳ（P0. 01）. Active phase of group Ⅳ was longer than other groups （P〈0. 05）. In group Ⅲ, second stage of labor was shorter than that in groupⅡ or group Ⅲ （P〈0. 05）. Satisfied analgesia effects were observed in groupⅡ and Ⅲ （P〈0. 05）. More cases received Oxytocin by intravenous infusion to strengthen uterine contraction in groupⅠ or groupⅡ than that in group Ⅰ or group Ⅳ. Rate of vaginal spontaneous labor in group Ⅲ showed significant difference in group Ⅰ or group Ⅱ （P〈0. 05）. Neonatal Apgar scores （1 or 5 rain） and blood gas parameters showed no significant difference in all patients. In group Ⅲ, the NBNA scores of the first day were the highest in groups Ⅰ,Ⅱ, Ⅲ. Condusion Epidural analgesia be given early in the first stage of labor and stopped when the uterine cervix dilated to 8 em can produce exact analgesia effects, shorten duration of labor, without influences of neonates, without increasing of cesarean section rate.