无痛分娩148例临床分析

Clinical analysis of 148 cases of painless labor

目的探讨腰硬联合麻醉（CSEA）用于分娩镇痛对产程、分娩方式、产后出血发生率和新生儿窒息发生率的影响。方法选择单胎头位足月临产孕妇，行低浓度布比卡因＋甲磺酸罗哌卡因＋芬太尼腰硬联合麻醉镇痛148例，与同期未使用镇痛药物单胎头位足月临产孕妇115例进行对比，观察其镇痛效果，及其对产程进展、分娩方式、产后出血和新生儿窒息发生率的影响。结果分娩镇痛组镇痛有效率达99．32％，分娩镇痛组总产程（493．74±150．88分钟）与对照组（381．42±134．97分钟）比较差异有统计学意义（t=-5．256，P〈0．01），其中分娩镇痛可引起第一产程时间延长（t=-4．572，P〈0．01）。分娩镇痛组和对照组的剖宫产率分别为14．86％和36．52％，差异有统计学意义（χ^2=16．484，P〈0．01）。分娩镇痛组和对照组的产后出血发生率（0．68％和0．87％）和新生儿窒息发生率（1．35％和0．87％）相比无明显差异（χ^2值分别为0．000、0．000，均P〉0．05）。结论腰硬联合麻醉镇痛用于分娩镇痛效果可靠，可明显降低剖宫产率，虽可使产程时间延长，但未出现产程延长超过正常者，且对产后出血和新生儿窒息发生率均无明显影响。

Objective To evaluate the influence of combined spinal-epidural analgesia （CSEA） on labor, delivery mode, incidence of postpartum hemorrhage and incidence of neonatal asphyxia in analgesic delivery. Methods Among primiparae with full term singleton fetus, 148 cases received CSEA with low concentration of bupivaeaine, ropivaeaine mesylate and fentanyl, who were compared with 115 cases at same period not using analgesic drugs. Then the analgesic effect and the influence on the progress of labor, delivery mode, incidence of postpartum hemorrhage and newborn asphyxia were observed. Results In labor analgesia group, the effective rate was 99.32% , and there was statistical diiterence in total stage ot labor between Iabor analgesia group ~ 4y3. /4 ~： 13v. oo mm/ anu comroJ group ~ .,o i. ＂＊~ -~ ^--＊. 7, rain） （t = -5. 256,P 〈 0.01 ）. The analgesia in delivery could prolong the first stage of labor（ t = -4. 572, P 〈 0.01 ）. The cesarean section rate in labor analgesia group and control group was 14.86% and 36.52% , respectively, and the difference was statistically χ2 slgmficant （χ2 = 16. 484, P 〈 0.01 ）. And the incidence of postpartum hemorrhage （0.68% in labor analgesia group and 0.87% in control group） and newborn asphyxia （1.35% in labor analgesia group and 0.87% in control group） was not significantly different （both χ2 = 0. 000, both P 〉 0.05 ）. Conclusion The effect of CSEA for labor analgesia is reliable, and the rate of cesarean section can be significantly reduced. Although the drugs prolong labor, it is not longer than normal labor, and there is no significant influence on the incidence of oostoartum hemorrhage and newborn asphyxia.