导乐镇痛仪和椎管内麻醉两种分娩镇痛方法对分娩质量的影响

Influence of Doula analgetic device and intraspinal anesthesia on delivery quality

目的比较导乐镇痛仪和椎管内麻醉两种分娩镇痛方法的临床效果及对产妇、新生儿的影响。方法将300例足月初产妇分为两组:Ⅰ组为使用导乐镇痛仪进行分娩镇痛;Ⅱ组为使用椎管内麻醉方法进行分娩镇痛;Ⅲ组为对照组即不使用分娩镇痛。每组各100例。观察镇痛起效时间、镇痛效果(分别在宫口开大4、6、9 cm时)、最终分娩方式、产后出血量以及新生儿Apgar评分(1、5、10 min)等。结果Ⅰ、Ⅱ两组的镇痛效果相当,无统计学意义,与Ⅲ组比较均有明显的统计学意义(P<0.05);Ⅱ组的镇痛起效时间[(10.00±2.84)min]短于Ⅰ组[(21.39±5.20)min](P<0.05);Ⅱ组的第一产程活跃期(386.95±31.07)min、第二产程(49.78±3.71)min较Ⅰ组第一产程活跃期(239.53±37.16)min、第二产程(38.92±3.58)min时间长(P<0.05);Ⅰ、Ⅱ两组的第三产程时间无差异;Ⅰ组的产后出血量(179.0±27.1)ml少于Ⅱ组产后出血量(249.10±25.15)ml(P<0.05);三组产妇的剖宫产率无差异,但Ⅱ组的阴道助产率(23%)高于Ⅰ组(6%)和Ⅲ组(8%),且差异有统计学意义(P<0.05);三组产妇的新生儿Apgar评分无差异。结论导乐仪肌肉电刺激分娩镇痛法镇痛效果与椎管内麻醉相似,对产程或宫缩的影响小,对新生儿无不良影响,操作简单方便,可以作为分娩镇痛的另一种安全、有效的措施供产妇选择。

Objective To compare the outcomes between neuromuscular electrical stimulation （via Doula analgetic device） and spinal anesthesia. Methods A total of 300 full-term primigravidae were randomized into three groups （n = 100/group）. Group Ⅰ used neuromuscular electrical stimulator; Group Ⅱ used spinal anesthesia; Group m （control group） did not use any analgetie. The observed indexes included analgesic time, analgesic effect （at the time point of cervix opening 4, 6 and 9 cm, respectively） , final delivery method, postpartum hemorrhage, Apgar score （at 1 , 5 and 10 min） and so on. Results Group Ⅰ and Group Ⅱ were of no statistically significant difference in analgesic effect ,but they both showed a statistical difference from Group Ⅲ （P 〈 0.05）. Analgesic time was shorter in Group Ⅱ （ 10.00 ± 2.84 min） than in Group Ⅰ （ 21.39 ± 5.20 min） （ P 〈 0. 05 ）. The first stage active phase （386.95 ± 31.07 min） and the second stage （49.78 ± 3.71 rain） of Group Ⅱ were longer than that of （239.53 ± 37.16, 38.92 ± 3.58 min） Group Ⅰ （P 〈 0.05 ） , at the third stage of labor, there was no difference between the two groups. The postpartum hemorrhage of Group Ⅰ was less than that of Group Ⅱ （179.00 ± 27.10 vs 249.10 ± 25.15 ml） （P 〈 0. 05）. There was no difference in caesarean section rate among the three groups, but the rate （23 % ） of assisted vaginal delivery of Group Ⅱ was higher than that （6% , 8% ） of Group Ⅰ and Group m （P 〈0 05） as for newborns＇ Apgar score, the three groups were of no difference. Conclusion Neuromuscular electrical stimulation via Doula analgetic device method is similar to spinal anesthesia on its effect of analgesia, and has less impact on delivery process or uterine contraction, without adverse effect on newborn. It may be used as an alternative analgesia method which is safety and effective.