双管硬膜外阻滞联合病人自控硬膜外镇痛在无痛分娩中的应用

Applications of double-catheter epidural block with patient controlled epidural analgesia in analgesia labor

目的评价双管硬膜外阻滞联合病人自控硬膜外镇痛(PCEA)下行无痛分娩的临床效果及可行性。方法选择2011年7～12月在我院住院、要求无痛分娩的初产妇40例(镇痛组),ASAⅠ～Ⅱ级,随机分为A﹑B组,A组行双点硬膜外穿刺置管,L1～2硬膜外行PCEA,L3～4进行连续硬膜外阻滞;B组为L2～3硬膜外行PCEA,方法同A组。观察A、B两组产程中的镇痛效果及不良反应,并与同期未采用无痛分娩的20例产妇(C组)对比。观察各组产程时间、分娩方式、新生儿情况、产后出血量及缩宫素使用情况。结果 A组和B组疼痛视觉模拟(VAS)评分与C组比较,差异均有统计学意义(P<0.01),且A组镇痛效果优于B组。各组产妇生命体征、新生儿Apgar评分、产程时间、产后出血及缩宫素使用情况比较,差异均无统计学意义(P>0.05)。结论双管硬膜外阻滞联合PCEA技术可安全应用于无痛分娩,不明显延长产程,不增加产后出血的发生率和缩宫素的使用,镇痛效果更好。

Objective To evaluate the clinical effect of epidural anesthesia by double-catheter with PCEA in analgesia la- bor. Methods We chose 40 first-pregnant women with the requirement for analgesia labor, ASA I ~ Ⅱ , and divided into two groups randomly. Group A interfered with double-catheter epidural block at the level of L1-2 and L3~4. Patient controlled epidural analgesia （PCEA） was given at the level of L1-2 and continually epidural blocks were given at Ls 4. The patients in group B were treated with the PCEA as same as group A at the level of L1-4. Furthermore, we selected 20 first-pregnant women who were not interfered with analgesia labor as group C. The effect of analgesia, the time of birth process, the way of birth, the newborns＂ Apgar scores, the amount of bleeding and the usage of oxytocin in each group were observed. Results The vital sign, newbo- rns Apgar score, birth process, as well as oxytocin application were similar in each group （P〉0.05）. Compared with group C, the visual analogue scale （VAS） had significant difference （P〈0.01） in group A and group B. Moreover, the VAS score in group A was less than that ingroup B. Conclusion The double-catheter epidural block with patient controlled epidural anal- gesia, which does not remarkably prolong the total stage of labor, increase the rate of postpartum hemorrhage, and increasingly apply oxytocin. It is safe and effective using in analgesia labor.