腰麻硬膜外联合麻醉在全产程中的镇痛效果及对母婴的影响

A STUDY ON COMBINED SPINAL-EPIDURAL ANESTHESIA: PAIN RELIEF AND EFFECTS ON MOTHERS AND INFANTS IN WHOLE STAGES OF LABOR

①目的 探讨腰麻硬膜外联合麻醉在全产程中的镇痛效果以及对母婴的影响。②方法 选择ASAⅠ～Ⅱ级、无禁忌证的单胎头位临产初产妇 30 0例 ,随机分为腰硬组 (腰麻硬膜外联合麻醉 )、硬外组 (硬膜外麻醉 )和对照组 (未用任何麻醉方法 )各 10 0例。行L2～ 3 椎间隙一点穿刺并一次成功。分别观察镇痛效果、起效时间、用药量、副作用、产程、分娩方式及母婴情况。③结果 腰硬组镇痛效果、起效时间以及用药量明显优于硬外组(uc=5 .34,t=16 .92～ 2 9.6 9,P <0 .0 1) ;与对照组比较 ,宫颈扩张加速 ,第一产程明显缩短 ,而第二产程延长 (t =3.34～ 4 8.4 9,P <0 .0 1) ,剖宫产率明显下降 ,而阴道助产率增高 ,胎儿宫内窘迫的发生率下降 (χ2 =6 .82～ 2 0 .35 ,P <0 .0 1)。④结论 腰麻硬膜外联合麻醉用于分娩镇痛优于硬膜外麻醉 ,是一种安全有效、更适合全产程镇痛的麻醉方法。

Objective\ To investigate the pain relieving effects of combined spinal epidural anesthesia(CSEA) during the whole stages o f labor and its influences on mothers and infants. \ Methods\ Three hundred in labor primipara of singleton pregnancy with vertex delivery ,in conformity with ASA Ⅰ-Ⅱ,without any contraindication s, were randomly divided into group CSEA,group CEA and control group( n =100 for each group). One point puncture was done on L 2-3 vertebra interval successfully. The analgesic effects,acting time,dosage of medicine,side effe cts,stage of labor,mode of delivery,postpartum hemorrhage,fetal distress and neonatal asphyxia were observed respectively.\ Results\ The analgesic effects,acting time and dosage of medicine in CSEA group obviously better than that in CEA ( u c=5.34 ,t=16.92-29.69, P <0.01).In group CSEA,the cervical dilation accelerated,the first stage of l abor was obviously shortened,the second stage had the tendency of being prolong ed ( t=3.34-48.49,P <0.01),the cesarean section rate decreased, low forceps delivery rate rose,the incidence of fetal distress decreased ( χ 2=6.82-20 .35, P <0.01).\ Conclusion\ CSEA in labor analgesia is much better than CEA. It i s a safe and effective anesthesia for total stage labor.