三种方法联合行阶梯式分娩镇痛的临床观察

Observation of the patients with combined three step ladder anesthesia method

目的比较三种方法联合行阶梯式分娩镇痛的镇痛效果及对产程和新生儿的影响。方法纳入住院分娩的ASAⅠ～Ⅱ级单胎头位无阴道分娩及硬膜外麻醉禁忌证的100例产妇,随机分为A、B两组,同时纳入住院的同条件不要求分娩镇痛的产妇50例。A组(阶梯式镇痛组)产程初期第一阶梯镇痛方法:一对一导乐分娩+水针减痛;第二阶梯(宫口<3 cm时)镇痛方法:一对一导乐分娩+笑气吸入;宫口≥3 cm时第三阶梯镇痛方法:一对一导乐分娩+腰硬联合阻滞镇痛;第四阶梯镇痛方法:(第二产程)一对一导乐分娩+(第三产程需会阴缝合)硬膜外阻滞镇痛。B组(单一方法分娩镇痛组)只在宫口≥3 cm时腰硬联合阻滞镇痛。C组不作任何镇痛措施。记录宫口开大1 cm、3 cm、6 cm、10 cm以及分娩结束时VAS评分;第一、二、三产程时间;新生儿Apgar评分和产妇的满意度。结果①A组比C组各时点VAS评分降低,差异有统计学意义(P<0.05),B组与C组比较在宫口开大6 cm、10 cm时VAS数值降低,差异有统计学意义(P<0.05),在产妇宫口开大1 cm、3 cm、分娩结束时A组比B组的VAS评分降低,差异有统计学意义(P<0.05)。②第一产程A、B两组比C组缩短,差异有统计学意义(P<0.05),A组与B组各产程时间差异无统计学意义(P>0.05);A、B组比C组的自然分娩率高、剖宫产率低且差异有统计学意义(P<0.05)。③A、B组比C组产妇的满意度高,且A组的优秀率最高,差异有统计学意义(P<0.05)。④三组新生儿Apgar评分差异无显著性(P>0.05)。结论三种方法联合行阶梯式分娩镇痛镇痛效果确切,可以缩短产程,降低剖宫产率,提高自然分娩率,产妇的满意度更高,更能体现出医疗服务的人文关怀。

Objective To evaluate effectiveness and effects on the labor and neonates of delivery with combined three step ladder anesthesia method.Methods One hundred delivery patients with ASAⅠ ～ Ⅱstage single cephalic vaginal delivery and epidural anethesia without contraindictions were divided into A,B groups..50 patients who had the same conditions but did not require anesthesia were also included into this study.The anesthesia method of group A（Three Step Ladder Anesthesia Method） included three steps,first step： one DAOLE and water injections reduce pain;second step（when cervix less than 3 cm） anesthesia： one DAOLE and inhaling nitrous oxide;third step anesthesia（when cervix more than 3 cm） ： one DAOLE and epidural anesthesia;fourth step anesthesia：（second stage） one DAOLE and（the third stage of labor required perineal） epidural anesthesia.The anesthesia method of group B（single method anesthesia group） when cervix more than 3cm,epidural anesthesia.Group C without ang anesthesic measures.VAS assessment was recorded when cervix 1cm,3 cm,6 cm,10 cm and at the end of childbirth;the first,second and third stage of labor;Apgar score and materanal satisfaction.Results ①The VAS score was significant lower in group A than that of group B（P 0.05）.When cervix 6 cm and 10 cm,the VAS score of group B was significantly lower that than that of group C（P 0.05）.When cervix more than1 cm,3 cm,at the end of childbirth VAS score of group A was significant lower than that of group B（P 0.05）.②First stage in A,B groups than in group C was significantly shorter（P 0.05）.The labor time difference of group A and group B was not statistically significant（P 0.05）.The high rate of natural childbirth,cesarean section rate was different and the difference was statistically significant of group A,B than in group C t（P 0.05）.③Group A,B were higher than C group on maternal satisfaction.The highest rate in group A of the outstanding difference was statistically significant（P 0.05）.④Apgar score three groups showed no significant difference（P 0.05）.Conclusion Three methods of analgesia Combined ladder anesthesia exact effect that can shorten labor,reduce the cesarean section rate and improve the natural birth rate,higher maternal satisfaction,better reflect the humane care medical services.