腰硬联合与硬膜外麻醉用于镇痛分娩临床效果分析

Clinical effects of combined spinal-epidural anesthesia and epidural anesthesia on labor analgesia

目的探讨椎管内麻醉镇痛分娩的优缺点及副作用发生率。方法回顾性分析西安安琪儿妇产医院行镇痛分娩396例临床病例,比较腰硬联合麻醉(联合组)和硬膜外麻醉(硬外组)麻醉后在镇痛效果、产程进展、产后出血量、新生儿评分方面的情况;并分析麻醉后在催产素使用、发热、产后尿潴留率等副作用及中转剖宫产的发生率。结果联合组镇痛起效时间明显短于硬外组(t=27.00,P<0.05),两组麻醉用于分娩镇痛效果均良好,VAS评分各时间点(5min、10min、30min、60min、90min)均无显著性差异(t值分别为1.41、0.71、1.46、1.54、1.75,均P>0.05)。两组三产程进展、产后出血量、新生儿评分(t值分别是1.02、0.44、1.05、1.46、1.85、1.56,均P>0.05)均无影响。两组麻醉后催产素使用、产时发热、产后尿潴留等副作用和中转剖宫产的几率无显著性差异(χ2值分别是0.00、0.10、0.08、0.05,均P>0.05)。结论腰硬联合麻醉的镇痛起效更快,麻醉后不增加催产素使用、产时发热、产后尿潴留率等副作用的发生几率。因此腰硬联合麻醉可广泛应用于分娩镇痛。

Objective To analyze the advantages and disadvantages and the probability of side effects of spinal anesthesia on labor analgesia. Methods Retrospective study was conducted among 396 parturients from Xi ＇an Angel Women and Children Hospital who accepted labor analgesia. Spinal-epidural anesthesia（ combination group） and epidural anesthesia（ epidural group） were compared in analgesia effect,labor progress,amount of blood loss after birth and Apgar score of newborns. Side effects caused by anesthesia were analyzed in both groups in the following aspects,using oxytocin,non-infection fever during labor and urinary retention as well as the percentage of conversion to cesarean section. Results The onset time was short in combined spinal-epidural anesthesia than in epidural anesthesia（ t = 27. 00,P 〈0. 05）. The effects of labor analgesia were good in both groups,and no significant difference in VAS score was found in each timepoint（ 5min,10 min,30min,60 min and 90min）（ t value was 1. 41,0. 71,1. 46,1. 54 and 1. 75,respectively,all P 〉0. 05）. No significant differences were found in labor progress,amount of blood loss after birth and Apgar score of newborns between two groups（ t value was 1. 02,0. 44,1. 05,1. 46,1. 85 and 1. 56,respectively,all P 〉0. 05）. There were no obvious differences in oxytocin using,non-infection fever during labor,urinary retention and conversion to cesarean section between two groups（ χ2value was0. 00,0. 10,0. 08 and 0. 05,respectively,all P〉 0. 05）. Conclusion Combined spinal-epidural anesthesia takes shorter time to relieve labor pain without increasing oxytocin using,non-infection fever during labor and urinary retention,so it can be widely used in labor analgesia.