双管硬膜外阻滞镇痛联合心理疗法对分娩结局的影响

Effect of double-catheter epidural block during labor analgesia combined with psychological treatment on delivery outcome

目的：探讨双管硬膜外阻滞镇痛联合心理疗法对分娩结局的影响。方法：选择黔南布依族苗族自治州人民医院产科2008年1月~2010年12月单胎、足月、初产妇160例,随机分成4组,双管硬膜外阻滞组（以下简称DCEA组）、心理疗法组、双管硬膜外阻滞＋心理疗法组（以下简称DCEA＋心理疗法组）和对照组。分别观察4组产妇SAS评分评价焦虑度、疼痛视觉模拟VAS评分、采用改良的Bromage评价运动阻滞情况、镇痛混合液总量、新生儿Apgar 1 min及5 min评分、分娩方式、血浆血管紧张素Ⅱ、皮质醇水平及产妇麻醉相关并发症的发生情况。结果：①DCEA＋心理疗法组入产室SAS评分分别与其他3组比较,有统计学意义（P〈0.01）;②DCEA＋心理疗法组在宫口扩张至5 cm及宫口扩张至10 cm时VAS评分分别与其他3组比较,有统计学意义（P〈0.01）;③DCEA组和DCEA＋心理疗法组Bromage评分分别与心理疗法组和对照组比较,有统计学意义（P〈0.05）;④DCEA＋心理疗法组缩宫素使用率、总产程时间及第二产程时间与其他3组比较,有统计学意义（P〈0.01）;⑤DCEA＋心理疗法组宫缩间隔时间和宫缩持续时间分别与心理疗法组和对照组比较,有统计学意义（P〈0.05）;⑥4组新生儿脐血pH、PO2、PCO2水平比较,无统计学意义（P〉0.05）;⑦DCEA＋心理疗法组分娩方式和剖宫产指征分别与心理疗法组和对照组比较,有统计学意义（P〈0.05）;⑧DCEA＋心理疗法组在宫口扩张至10 cm及胎儿娩出时血浆血管紧张素Ⅱ、皮质醇水平与心理疗法组和对照组比较,有统计学意义（P〈0.05）;⑨DCEA组产妇总体满意率为80.00%、心理疗法组为65.00%、DCEA＋心理疗法组为100.00%、对照组为40.00%,DCEA＋心理疗法组产妇总体满意率与其他3组比较,有统计学意义（P〈0.01）。结论：双管硬膜外阻滞联合心理疗法用于产妇分娩镇痛,可强化镇痛效果并减少用药量,对分娩结局无不良影响。

Objective：To explore the effect of double-catheter epidural block during labor analgesia（DCEA） combined with psychological treatment on delivery outcome.Methods：160 single pregnancy,full term and primiparous women were selected from the department of obstetrics in the hospital from January 2008 to December 2010,then they were divided into DCEA group,psychological treatment group,DCEA combined with psychological treatment group and control group.The degrees of anxiety evaluated by SAS value,VAS scores,moter block situations assessed by modified Bromage value,the total dose of analgesia mixture,Apgar scores of neonates（1 minute and 5 minutes）,delivery modes,plasma angiotension Ⅱ and cortisol levels,the incidences of anesthesia-related complications of lying-in women in the four groups were observed.Results：There was significant difference in SAS score between DCEA combined with psychological treatment group and the other three groups（P0.01）.When the dilatation of cervix reached 5 cm and 10 cm,there was significant difference in VAS score between DCEA combined with psychological treatment group and the other three groups（P0.01）.There was significant difference in Bromage score between DCEA group,DCEA combined with psychological treatment group and the other two groups,respectively（P0.05）.There was significant difference in the application rate of oxytocin,the total time of labor and the time of the second stage of labor between DCEA combined with psychological treatment group and the other three groups（P0.01）.There was significant difference in interval time and duration time of uterine contraction between DCEA combined with psychological treatment group and psychological treatment group,control group,respectively（P0.05）.There was no significant difference in pH,PO2 and PCO2 levels in umbilical blood among the four groups（P0.05）.There was significant difference in delivery modes and indications of cesarean section between DCEA combined with psychological treatment group and psychological treatment group,control group,respectively（P0.05）.When the dilatation of cervix reached 10 cm and at birth,there was significant difference in plasma angiotension Ⅱ and cortisol levels between DCEA combined with psychological treatment group and psychological treatment group,control group,respectively（P0.05）.The satisfaction rates in DCEA group,psychological treatment group,DCEA combined with psychological treatment group and control group were 80.00%,65.00%,100.00% and 40.00%,respectively,there was significant difference in satisfaction rate between DCEA combined with psychological treatment group and the other three groups（P0.01）.Conclusion：Double-catheter epidural block during labor analgesia combined with psychological treatment can enhance the analgesic effect and reduce the dose of drugs,which has no adverse impact on delivery outcome.