硬膜外镇痛联合导乐方式在初产妇分娩镇痛中的效果

Effects of epidural analgesia combined with Doula method （ 导乐 ） on labor analgesia in primiparous women

目的观察硬膜外镇痛联合导乐方式在初产妇分娩镇痛中的效果。方法初产妇分娩600例，ASAⅠ级，随机分为3组：硬膜外镇痛组（A组）、导乐组（助产士指导，B组）、硬膜外镇痛联合导乐组（C组），各组分别完成产道分娩者168、166、170例。记录各组产妇的镇痛情况，采用视觉模拟评分法（VAS）评价其镇痛效果、采用改良Bromage评分评价其神经阻滞情况，记录各组产妇的产程、满意度、分娩方式、新生儿Apgar评分与不良反应。结果A、C两组镇痛后15min时VAS评分较镇痛前降低（P〈0．05）。B、C组第一、第二产程较A组短（P〈0．05）。c组产妇的满意度较A、B两组高（P〈0．05）。结论硬膜外镇痛联合导乐方式应用于分娩镇痛效果好，对产妇及新生儿无影响，产程缩短。

Objective To observe the clinical effects of epidural analgesia combined with Doula method （ 导乐） on labor analgesia in primiparous women. Methods Six hundred ASA Ⅰ primiparas were randomly divided into three groups. Epidural analgesia was used in group A, Doula method （guiding by midwife） in group B, and epidural analgesia combined with Doula method was used in group C. 168,166 and 170 cases finished the vaginal delivery in the three groups respectively. The visual analogue scale （VAS） , modified Bromage score （MBS）, duration of labor, maternal satisfaction, mode of deliveries and neonatal Apgar score were recorded. Results VAS was significantly lower than pre-analgesia at 15 min after analgesia in group A and C （P〈 0.05）. Duration of the first and second stages of parturition in group B and C was significantly shorter than that in group A （P〈 0.05）. The maternal satisfaction score was significantly higher in group C than that in group A and B（P〈 0.05）. Conclusion Epidural analgesia combined with Doula method for labor analgesia is effec- tive, and can shorten the labor stage with little impact on the primiparas and the neonates.