患者自控硬膜外分娩镇痛对母婴影响的临床观察

CLINICAL INVESTIGATION OF PATIENT CONTROLLED EPIDURAL ANALGESIA ON THE NULLIPAROUS WOMEN AND NEONATES DURING LABOR

目的：比较产妇分娩时患者自控硬膜外镇痛（patientcontrolledepiduralanalgesia，PCEA）对母婴的影响。方法：自愿接受分娩镇痛足月、单胎、头位初产妇120例，宫口扩张3cm时随机分为两组：舒芬太尼混合罗哌卡因PCEA组（s组），芬太尼混合罗哌卡因PCEA组（F组）。当产妇官口开至3cm时，S组硬膜外注射0．1％罗哌卡因和0．5μg／ml舒芬太尼混合液5ml，随后以0．1％罗哌卡因和0．5μg／ml舒芬太尼混合液行PCEAEF组混合液中则以2μg／ml芬太尼替代0．5嵋／m1舒芬太尼。另外未要求行任何镇痛处理的60例产妇为对照组（c组）。三组胎儿娩出后行血气分析，记录新生儿1和5minApgar评分和出生后1～5d的新生儿神经行为（neonatalbehavioralneurologicalassessments，NBNA）评分。结果：三组间血气分析的各项指标的差异均无统计学意义（P〉0．05）。s组与F组间PCEA用量、按压次数、总按压次数／有效按压次数的差异无统计学意义俨〉0．05）。s和F组产妇使用催产素的构成比明显高于C组（尸〈0．01）。三组问器械助产、剖宫产率和新生儿1和5minApgar评分的差异无统计学意义（P〉0．05）。新生儿出生后第1d，F组的NBNAl显著低干S组和C组（P〈0．05）。三组问NBNA2、NBNA3、NBNA4和NBNA5评分的差异均无统计学意义（P〉0．05）。结论：产妇分娩时应用舒芬太尼0．5μg／ml或芬太尼2μg／ml复合0．1％罗哌卡因均能提供满意日安全的分姊镇痛．对母婴矛明昂不电影口向．

Objective： To investigate the clinical effects of patient controlled epidural analgesia （PCEA） on the nulliparous women and neonates during labor. Methods： One-hundred and twenty nulliparous parturients in active labor （cervical dilation = 3 cm） were randomly and evenly divided into group S and F. In group S （n = 60）, 0.1% ropivacaine plus sufentanil 0.5 μ g/ml （5 ml mixture） was injected epidurally, followed by PCEA with 0.1% ropivacaine plus sufentanil 0.5 μ g/ml. In group F （n = 60）, the treatment was the same as in group S, excepte in the mixed solution, fentanyl 2 μg/ml substituted sufentanil fentanyl 0.5 μg/ml. In group C （n = 60）, parturients did not receive any analgesia according to their personal preference. Arterial blood gas parameters of newborn infants were collected after birth. Apgar score of neonates in 1 and 5 min, neonatal behavioral neurological assessments （NBNA） 1 - 5 days after birth were recorded. Results： There was no significant difference in the arterial blood gas parameters among three groups. There was no significant difference in PCEA dosage, pressing times, total number of the effective press times/total press times between group S and F. The oxytocin consumption in group S and F was significantly higher than that in group C. There was no significant difference in percentage of cesarean section and instrumental delivery, and Apgar score among three groups. At the first days of birth, NBNA1 in group F was lower than that in group S and C （P 〈 0.05）. There was no significant difference in NBNA2,NBNA3, NBNA4 and NBNA5 scores among three groups. Conclusion： PCEA with sufentanil 0.5 μg/ ml （or fentanyl 2 μg/ ml） plus 0.1% ropivacaine can provide satisfactory and safety delivery analgesia on mother and infant, without obvious adverse effect on mother and infans.