腰-硬联合麻醉结合自控镇痛在初产妇分娩镇痛中的应用效果

Application Effects of CSEA Combined with PCEA on the Labor Analgesia in Primipara

[目的]探讨腰麻-硬膜外联合麻醉（CSEA）结合自控镇痛（PCEA）在初产妇分娩镇痛中的应用效果。[方法]选择本院住院待产的足月初产妇996例，根据孕妇及家属意愿分为观察组（n=503）和对照组（n=493）。观察组行CSEA＋PCEA镇痛，对照组常规分娩处理，并采用PCEA。观察两组患者镇痛效果、产程进展、缩宫素使用情况、产后出血发生率、羊水Ⅲ度污染率、新生儿窒息发生率、产钳助产率、剖宫产率及不良反应情况。[结果]观察组Ⅰ级和Ⅱ级疼痛比例显著优于对照组，且差异有显著性（P〈0．05）；观察组活跃期、第一产程、第二产程时间较对照组均有所延长（P〈0．05）；观察组宫缩持续时间较对照组缩短（P〈0．05）；两组缩宫素使用率、产后出血发生率、羊水Ⅲ度污染、新生儿窒息发生率、产钳助产率、剖宫产率及不良反应发生率比较差异均无显著性（P〉0．05）。[结论]CSEA＋PCEA镇痛效果显著，虽会延长第一产程、第二产程，但对分娩结局无不良影响。

[Objective]To investigate the application effects of CSEA combined with PCEA on the labor analgesia in primipara. [Methods]The study subjects consisted of 996 cases of full-term primipara, and according to the wishes of the pregnant women and their families, they were divided into the observation group （ n = 503） and control group （ n =493）. The observation group was treated with CSEA＋PCEA, and the control group was treated with routine labor and PCEA. The analgesic effects of the two groups of patients, the production process, oxytocin element, postpartum hemorrhage, amniotic fluid pollution Ⅲ degree, neonatal asphyxia, forceps delivery, cesarean section, and adverse reaction conditions were observed and analyzed. [Results]The analgesic effect of the observation group was significantly better than that of the control group （ P 〈0.05）. The active period of the observation group, the first stage of labor, and the second stage of labor time were longer in the observation group than in the control group （ P 〈0.05）. The observation group＇s contraction duration was shorter than the control group （ P 〈0.05）. Two groups＇ rates of oxytocin, postpartum hemorrhage, amniotic fluid pollution Ⅲ degree, asphyxia of the newborn, forceps delivery, cesarean section, and adverse reactions were not significant difference （ P 〉0.05）. [Conclusion]Combination of CSEA ＋ PCEA has a great analgesic effect, although it may prolong the first and second stages of labor. It did not increase uterine contraction, forceps and cesarean section rate, or the outcome of delivery with adverse effects.