硬膜外预置管用于经产妇分娩镇痛临床分析

Clinical analysis of epidural preset tube in multipara labor analgesia

目的探讨硬膜外预置管阻滞用于经产妇分娩镇痛的有效性、及时性、安全性,提高经产妇分娩镇痛率和质量。方法选择2013年5月~2014年10月我院住院待产的足月经产妇270例为研究对象,根据研究要求分为三组,其中观察组（A组）运用PCEA的分娩镇痛方式;对照1组（B组）运用连续硬膜外分娩镇痛;对照2组（C组）未经分娩镇痛,观察三组产妇的生命体征、胎心,记录第一、二、三产程时间及疼痛的视觉模拟评分（VAS评分）、Bromage评分、分娩方式、缩宫素使用率、新生儿Apgar评分、产妇出血量、会阴裂伤发生率等。结果三组产妇的一般资料如年龄、身高、体重、孕周比较,差异均无统计学意义（P〉0.05）;三组的产程、会阴裂伤发生率相比差异有统计学意义（P〈0.05）;观察组和对照1组在缩宫素使用率、剖宫产率、新生儿窒息率评分、产后出血量方面差异无统计学意义（P〉0.05）;观察组与对照2组在缩宫素使用率、剖宫产率、新生儿窒息率评分、产后出血量比较有统计学意义（P〈0.05）。结论连续硬膜外预置管法阻滞用于经产妇分娩镇痛安全有效,可以提高对产科并发症的手术麻醉处理的及时性、有效性,减少会阴裂伤发生率,增加经产妇分娩的安全性。

Objective To investigate the validity, timeliness and security of epidural preset tube to block multipara labor analgesia, and to improve maternal labor analgesia rates and quality. Methods A total of 270 cases of mature maternal in our hospital from May 2013 to October 2014 were chosen for the study, according to the study requirements,and they were divided into three groups. The observation group（group A） received PCEA labor analgesia method, and the control group1（group B） received continuous epidural labor analgesia method, and the control group 2（group C） did not undergo analgesia. Maternal vital signs and fetal heart rate in the three groups were observed, and the first stage of labor, the second stage of labor and the third stage of labor, pain visual analog scale（VAS score）, Bromage score, mode of delivery, oxytocin usage rate, newborn Apgar score, maternal hemorrhage amount and the incidence of perineal laceration were recorded. Results There were not statistically significant differences in comparing general information of the 3 groups such as age, height, weight, gestational age（P〉0.05）. The differences in stage of labor and the incidence of perineal laceration in the three groups were statistically significant（ P〈0.05）. The differences were not statistically significant in comparing oxytocin usage rate, cesarean section rate, neonatal asphyxia score, postpartum hemorrhage amount of the observation group and the control group 1（P〉0.05）. The differences were statistically significant in comparing oxytocin usage rate, cesarean section rate, neonatal asphyxia score and postpartum hemorrhage amount in the observation group and the control group 2（P〈0.05）. Conclusion Continuous epidural preset tube method to block maternal labor analgesia is safe and effective, can improve the timeliness and effectiveness of obstetric complications anesthesia process, reduce the incidence of perineal laceration, and increase maternity delivery security.