不同镇痛方法对初产妇分娩镇痛及分娩结局的影响

EFFECTS OF DIFFERENT ANALGESIC METHODS FOR LABOR PAIN AND DELIVERY IN PRIMIPARA

目的通过比较一氧化二氮(笑气)吸入镇痛、水中镇痛和瑞芬太尼静脉自控镇痛在初产妇分娩镇痛中的效果,分析不同镇痛方法对母儿的影响。方法收集在我院选择无痛分娩的单胎足月初产妇105例,随机分为笑气组、水中组和静脉组3组,每组35例,分别采用笑气吸入镇痛、水中镇痛和瑞芬太尼静脉自控镇痛,观察各组的镇痛效果、产程进展、缩宫素使用、分娩方式、产后出血及新生儿窒息情况。结果 3组初产妇总产程、第二产程、产后2h及产后24h出血量、分娩方式和新生儿Apgar评分比较,差异无显著性(P>0.05);水中组镇痛效果与静脉组相似,与笑气组相比差异有显著性(Z=-2.859,P<0.05);水中组缩宫素应用例数明显少于静脉组,差异有显著性(χ2=5.280,P<0.05)。结论水中镇痛可有效缓解产妇的分娩疼痛并减少产程中的干预,对母儿影响较少,是一种安全有效的镇痛方法。

Objective To compare different methods of analgesia-nitrous oxide（laughing gas）inhalation analgesia,water-immersion analgesia and remifentanil patient-controlled intravenous analgesia（PCIA）-for labor pain in primiparas,and analyze the effects of different methods on mother and newborn. Methods One hundred and five singleton and full-term primiparas who choosed painless delivery were enrolled,and evenly randomized to three groups.They were given laughing-gas inhalation analgesia,water-immersion analgesia or remifentanil patient-controlled intravenous analgesia,respectively.The analgesic effect,birth process,use of oxytocin,mode of delivery,postpartum hemorrhage and neonatal asphyxia were observed. Results The differences between the three groups were not significant with regard to total stage of labor,second labor stage,amount of bleeding 2and 24 hours after childbirth,mode of delivery and neonatal Apgar score（P〉0.05）.The effectiveness of water-immersion analgesia was similar to PCIA,and the difference was significant as compared with the laughing gas（Z=-2.859,P〈0.05）.The cases of oxytocin application in water-immersion group were less than PCIA（χ2=5.280,P〈0.05）. Conclusion Water-immersion analgesia,a safe and effective analgesia approach,can effectively relieve labor pain and decrease intervention in birth process,and less impact on mother and newborn.