硬膜外麻醉与腰硬联合麻醉在分娩镇痛中的应用比较

Comparison of Application of Epidural Anesthesia and Combined Spinal and Epidural Anesthesia in the Labor Analgesia

目的对分娩过程中硬膜外麻醉与腰硬联合麻醉的镇痛效果进行对比分析。方法选取该院2016年5月—2017年5月期间收治的128例产妇进行研究,随机分为观察组与对照组,各64例,对照组产妇麻醉方式为硬膜外麻醉,观察组产妇麻醉方式为腰硬联合麻醉,对两组产妇不同时间段VAS评分及镇痛起效时间、产程时间、镇痛维持时间、剖宫产率、新生儿Apgar评分及缩宫素使用率等指标进行对比。结果在VAS评分方面,两组产妇在T1~T5时间段VAS评分均明显低于T0时间段(P<0.05),且观察组在T1~T3时间段VAS评分低于对照组,差异有统计学意义(T1:t=3.827;T2:t=3.569;T3:t=3.342,P<0.05);镇痛起效时间方面,观察组(2.86±1.36)min明显低于对照组(6.63±2.49)min,差异有统计学意义(t=8.473,P<0.05);剖宫产率及缩宫素使用量方面,观察组分别为32.81%、6.25%,均明显低于对照组的56.25%、21.88%,差异有统计学意义(剖宫产:χ~2=7.108;缩宫素:χ~2=9.824,P<0.05)。结论产妇生产中应用腰硬联合麻醉方式,具有持续硬膜外麻醉与腰麻双重优势,麻醉起效时间快,可有效降低剖宫产率,分娩镇痛效果较好,在临床中有推广应用的价值。

Objective To compare and analyze the effect of epidural anesthesia and combined spinal and epidural anesthesia in the labor analgesia. Methods 128 cases of delivery women admitted and treated in our hospital from May2016 to May 2017 were selected and divided into two groups with 64 cases in each, the control group and the observation group were respectively treated with epidural anesthesia and combined spinal and epidural anesthesia, and the VAS scores at different time periods, analgesia onset time, labor course time, analgesia maintenance time, cesarean section rate, Apgar score and oxytocin usage rate were compared between the two groups. Results The VAS scores at T1-T5 of the two groups were obviously lower than those at T0,（P〈0.05）, and the VAS scores at T1-T3 in the observation group were lower than those in the control group, and the differences were statistically significant（T1： t=3.827; T2： t=3.569; T3： t=3.342; P〈0.05）, and the analgesia onset time in the observation group was obviously lower than that in the control group [（2.86±1.36）min vs（6.63±2.49）min], and the difference was statistically significant（t=8.473, P〈0.05）, and the cesarean section rate and oxytocin usage rate in the observation group were obviously lower than those in the control group（32.81%, 6.25% vs 56.25%,21.88%）, and the difference was statistically significant（cesarean section： χ^2=7.108; oxytocin; χ^2=9.824, P〈0.05）. Conclusion The application of combined spinal and epidural anesthesia in the labor of the delivery women have the double advantages of continuous epidural anesthesia and lumbar anesthesia, with rapid anesthesia onset time, which can effectively reduce the cesarean section rate with better delivery analgesic effect,and it is of promotion and application value in clinic.