主动镇静在快乐分娩中的应用

Active sedative application in happy childbirth

目的通过依据Narcotrend指数(Narcotrend index,NI)指引,在无痛分娩中比较主动镇静的可行性,评估其在分娩中应用的安全性、有效性。方法选择ASAⅠ~Ⅱ级初产妇200例,随机平分为A组(椎管内镇痛分娩,NI为90~100:清醒组)、B组(主动镇静,NI为75~85:异丙酚靶控)。产妇分娩过程中,两组均记录基本生命体征:血压、心率、呼吸频率及脉搏氧饱和度,同时比较两组产妇的产程时间、胎心率、视觉模拟评分法(visual analogue scale,VAS)、催产素和助产器械使用情况、剖宫产率及新生儿Apgar评分。结果两组在b点后的血压、心率、呼吸频率差异有统计学意义(P<0.05),两组VAS、助产器械使用及剖宫产率的比较差异有统计学意义(P<0.05);催产素使用情况两组差异无统计学意义(P>0.05);母婴安全方面:脉搏氧饱和度、产程、胎心率及新生儿Apgar评分两组数据差异无统计学意义。结论在NI指引下主动镇静实施镇痛分娩安全有效,可以避免产妇的非自然分娩的增加。

Objective Assess the safety and effectiveness of its application in childbirth by comparing the feasibility of active sedation in painless childbirth according to the Narcotrend Index(NI)guidelines.Methods A total of 200 ASAⅠ~Ⅱprimiparous women were randomly divided into two groups:group A(intraabdominal pain delivery,NI 90~100:awake group),group B(active sedation,NI 75~85:propofol Target control).During maternal delivery,basic vital signs were recorded in both groups:blood pressure,heart rate,respiratory rate and pulse oxygen saturation.The duration of labor,fetal heart rate,visual analogue scale(VAS)Oxytocin and midwifery use,cesarean section rates and neonatal Apgar scores.Results The blood pressure,heart rate and respiration rate of group A were significantly different(P<0.05).The VAS,midwifery and cesarean section rate were significantly different(P<0.05);The differences between the two groups of oxytocin use were not statistically significant(P>0.05).There was no significant difference between the two groups in the comparison of pulse oxygen saturation,labor course,fetal heart rate and neonatal Apgar score.Conclusion Active sedation under ni guidance to implement analgesic delivery is safe and effective,can avoid the increase of unnatural delivery.