硬膜外阻滞全程分娩镇痛对产妇有效性和新生儿的安全性探讨

Whole-course epidural block for analgesic delivery:efficacy in puerperas and safety in neonates

目的:评价全程硬膜外镇痛术对新生儿安全性的影响。方法:收集本院随机分配40例无产科及硬膜外阻滞禁忌证的单胎初产妇,随机分为2组,每组20例。Ⅰ组为常规分娩镇痛组,Ⅱ组为全程分娩镇痛组。对两组产妇行硬膜外阻滞,分别观察子宫收缩情况,总产程,分娩方式,新生儿血气分析,体重及新生儿阿氏评分。结果:Ⅱ组在实施镇痛后30 min时子宫收缩力抑制最明显(P<0.05),但过后可逐渐恢复至正常水平。共5例需行剖宫产,剖宫产产妇的宫缩加强情况与两组中阴道分娩产妇宫缩加强差异无统计学意义(P<0.05),两组的第二、三产程、分娩方式、新生儿阿氏评分、体重、脐静脉血气分析及新生儿转归等比较差异无统计学意义(P>0.05)。结论:分娩全程硬膜外镇痛无延长第二、三产程时间,对新生儿无影响。

Objective：To assess the safety of whole-course epidural analgesia in neonates. Methods： Forty nulliparas in singleton pregnancy who did not have eontraindications for epidural block were enrolled from First Affiliated Hospital of Guangzhou Medical College and were randomly assigned to receive routine analgesic delivery （group I ） and whole-course analgesic delivery （group Ⅱ ）, respectively. All primiparas were subjected to epidural block for further comparison on uterine contraction,way of delivery, blood gas analysis of neonates, body weight of neonates and Apgar scores. Results ：The uterine contraction was most intensively inhibited in group Ⅱ at 30 minutes after analgesia （ P 〈 0. 05 ） and was subsequently renormalized. Of 5 cases required cesarean resection, the intensified uterine contraction did not differ statistically with those who underwent vaginal delivery （ P 〈 0. 05 ）. Additionally, the difference in the duration of the second and third courses, way of delivery, Apgar score for neonates, body weight of neonates, blood gas analysis of umbilical vein and neonatal prognosis did not reach statistical significance （ all P 〉 0.05 ）. Conclusion ： Whole-course epidural block for delivery is associated with neither prolonged second or third course of delivery nor adverse impacts on the neonates.