腰硬联合麻醉对初产妇无痛分娩的麻醉效果研究

Study on the anesthesia effect of combined spinal-epidural anesthesia on painless delivery of primipara

目的研究腰硬联合麻醉对初产妇无痛分娩的麻醉效果。方法96例初产妇,以双盲法原则分为参照组和试验组,各48例。参照组予以自然分娩,分娩全程不采取镇痛干预;试验组采取腰硬联合麻醉进行无痛分娩。比较两组疼痛程度、产程耗时、分娩后出血量、并发症发生率、剖宫产率及胎心率。结果试验组疼痛程度明显优于参照组,差异有统计学意义(P<0.05)。两组第一、二、三产程耗时及分娩后出血量比较,差异无统计学意义(P>0.05)。试验组发生新生儿窒息1例、产后大出血1例,并发症发生率为4.17%(2/48);剖宫产率为4.17%(2/48);参照组发生新生儿窒息3例、产后大出血5例,并发症发生率为16.67%(8/48);剖宫产率为20.83%(10/48)。试验组并发症发生率及剖宫产率低于参照组,差异有统计学意义(P<0.05)。试验组胎心率为(132.05±6.20)次/min,与参照组的(133.02±5.34)次/min比较,差异无统计学意义(P>0.05)。结论初产妇无痛分娩中采取腰硬联合麻醉可获得满意镇痛效果,且能有效减少并发症,亦可促进剖宫产率下降,属安全有效镇痛模式,值得推广。

Objective To study the anesthesia effect of combined spinal-epidural anesthesia on painless delivery of primipara.Methods A total of 96 primipara were divided into reference group and experimental group according to the principle of double-blind,with 48 cases in each group.The reference group had a spontaneous delivery without analgesic intervention during the delivery,while the experimental group had a combined spinal-epidural anesthesia for painless delivery.Both groups were compared in terms of pain degree,labor duration,postpartum blood loss,complication rate,cesarean section rate and fetal heart rate.Results The pain degree of the experimental group was significantly better than that of the reference group,and the difference was statistically significant(P<0.05).The differences were not statistically significant between the two groups when comparing time-consuming of the first,second,and third stage of labor and postpartum blood loss(P>0.05).In the experimental group,1 case of neonatal asphyxia and 1 case of postpartum hemorrhage occurred,with a complication rate of 4.17%(2/48);the cesarean delivery rate was 4.17%(2/48).In the reference group,3 cases of neonatal asphyxia and 5 cases of postpartum hemorrhage occurred,with a complication rate of 16.67%(8/48);the cesarean delivery rate was 20.83%(10/48).The complication rate and cesarean section rate in the experimental group were lower than those in the reference group,and the difference was statistically significant(P<0.05).The fetal heart rate in the experimental group was(132.05±6.20)beats/min,which was not significantly different from(133.02±5.34)beats/min in the reference group(P>0.05).Conclusion The combined spinal-epidural anesthesia can achieve satisfactory analgesic effect in primipara during painless delivery,and can effectively reduce complications and of cesarean section rate.It is a safe and effective analgesic mode,and is worthy of promotion.