导乐陪伴分娩联合导乐仪镇痛在产程中对母婴的作用和影响

Influence of doula combined with pharmacological analgesia during labor on mother and infant

目的对比导乐陪伴联合导乐仪镇痛与椎管内麻醉对母婴的作用和影响。方法选择正常足月初产妇235例完全随机分为导乐仪组（110例）和椎管组（125例）。2组由导乐助产士陪伴分娩，导乐仪组导乐助产士指导下产妇迫切需要镇痛时使用导乐仪、椎管组使用麻醉药（芬太尼2．5μg/ml＋0．125％罗哌卡因共2m1）注人蛛网膜下腔，在整个分娩过程中观察镇痛效果、产程进展、分娩方式、产后出血与新生儿情况。结果椎管组镇痛有效率[98．4％（123／125）]优于导乐仪组[77．3％（85、110）]，导乐仪组第1、2产程时间[（105±32）min、（39±16）min]均短于椎管组[（163±33）min、（50±197）min]，差异有统计学意义（P〈0．05）；导乐仪组阴道正常产、阴道助产和剖宫产率分别为58．2％（64／110）、12．7％（14／110）和29．1％（32／110），椎管组则分别为42．4％（53／125）、25．6％（32／125）和32．0％（40／125），组间差异均有统计学意义（P〈0．05）；2组产妇产后2h出血量差异无统计学意义[（185±87）ml比（190±92）ml，P〉0．05]。结论导乐仪组产程时间短，椎管组镇痛效果满意，因此，导乐陪伴联合椎管内麻醉与导乐仪镇痛是目前较理想的分娩镇痛方法，对母婴无不良影响，选择何种方法，在临床T作中应根据具体情况具体应用。

Objective To investigate the effect of Doula instrument combined with spinal anesthesia and analgesia on mother and infant. Methods Women with normal fulherm primipara were randomly divided into 2 groups： 125 cases of spinal anesthesia for labor analgesia in spinal group, 110 cases of doula plus labor analgesia group. The 2 groups were observed of maternal analgesia, duration of labor, mode of delivery, postpartum hemorrhage and neonatal score. Results The analgesic effect of spinal group was superior to that of Doula instrument group; labor time in each instrmnent group was shorter than that in the spinal group, the difference was statistically significant （ P 〈 O. 05 ） ; delivery methods between 2 groups had a significant difference （ P 〈 0.05 ） ; maternal postpartum blood loss and the incidence of neonatal asphyxia rate between 2 groups was not significant （ P 〉 0.05）. Conclusions Doula group shows short labor time and spinal group has good analgesia effects. Doula combined with spinal anesthesia is an ideal method for labor analgesia without adverse effects.