两种分娩镇痛方法临床比较

The clinical study on labor pain relief by conducting two different methods

目的 比较采用腰麻 -硬膜外联合麻醉 (CSEA)和病人自控镇痛 (PECA)的分娩镇痛法与氧化亚氮吸入法的镇痛效果及对母婴的影响。 方法 自愿接受分娩镇痛及无产科和麻醉禁忌症的足月孕初产妇 10 0例 ,随机分为 CSEA+ PCEA组和氧化亚氮组各 50例 ,CSEA+ PCEA组蛛网膜下腔注射 0 .2 %罗哌卡因 3 m g后 3 0 min,PECA输注 0 .1%罗哌卡因与 2 .0μg/ml芬太尼混合液 ,单次剂量 5ml,锁定时间 15min,或持续背景速度 8m l/h,按需追加 3 .0 ml/h,于宫口开全停泵 ;氧化亚氮组产妇于感觉到子宫收缩痛之前 45～ 60 s,自行手持面罩紧贴口鼻部 ,深吸混合气体 2～ 3口 ,再松开面罩。再次宫缩前 45～ 60 s,再次吸入 ,如此反复 ,至胎儿娩出。采用视觉模拟疼痛评分 (VAS)评估镇痛效应 ,运动阻滞程度按改良的 Bromage标准进行测定 ,分别观察疼痛程度、副作用、产程时间、分娩方式、产后出血、新生儿情况。 结果 第一产程 CSEA+ PCEA组 VAS评分为 (3 1.4± 14 .4)分 ,氧化亚氮组为 (67.2± 2 7.3 )分 ,2组镇痛效果比较 ,差异有显著性 (P<0 .0 1) ;第二产程 2组 VAS评分 ,差异无显著性 (P>0 .0 5) ;产程时间比较 ,第一产程差异无显著性 (P>0 .0 5) ;第二产程 CSEA+ PCEA组 (67.2± 46.6) min较氧化亚氮组 (43 .3± 2 1.4) m

ObjectiveTo study the effectiveness of pain rel ief of combined spinal epidural analgesia (CSEA) with patient controlled analge sia (PCEA),and compared it to inhaling nitrous oxide and their influences on mot hers and infantsMethodsOne hundred primigravidae at full tim e that requested labor analgesia on the first labor,who had a single fetus with vertex presentation and were expected to have a vaginal delivery,were randomly d ivided into a CSEA+KPCEA group (50 case) and a nitrous oxide group (50 cases).In CSEA+PCEA group,0 2 % ropivacaine,which was 3 mg (1 5 ml),was injected into s ubarachnoid space.Epidural catheter was advanced cephalad for 3 5 cm and connec ted to the PCA pump.Thirty minutes after intrathecal injection,a mixture of 0 1 % ropivacaine and 2 0 μg/ml fentany were used for PCEA.The primipara were all ocated to one of two PCEA regimen:in PCEA regimen 1 the bolus dose was 5 ml wit h a 15 minutes lockout interval,and there was no background infusion;in PCEA reg imen 2,the bolus dose was 3 ml with a 15 minutes lockout interval,and the backg round infusion was at 8 ml/h.In the nitrous oxide group,the puerperants deeply i nhaled the Nitrous oxide that premixed with oxygen(50 %∶50 %) 2 3 times before uterus systoling 45 60 s,then loosed the pneusis device,and conducted the seco nd inhaling before uterus systoling by 45 60 s.Then,the fetus was delivered.The intensity of pain was evaluated by puerperas VAS,and the motor function was ass essed by modified Bromage score.Side effects,labor course,delivery mode,and the incidences of postpartum hemorrhage,In the CSEA+PCEA group,the score of (Good～satisfaction) was (31 4±14 4),and in the nitrous oxide group,the score was.fetal distress and neonatal asphyxia were obse rved in the two groups respectively.Results In teh CSEA+PCEA group,the scare of Good analgesia achieved with high primipara satisfaction was (31 4±14 4),and in the nitrous oxide group,the score was (67 2±27 3)score.In the first stage of labor,there was significant difference in VAS score between the CSEA+PCEA group and the the nitrous oxide group (P<0 01),but in the second stage of labor,there was no significant d ifference(P>0 05).The difference between the mean time of the first labor stage,and the duration of the second labor stage were (67 2+46 6) minutes in the CSEA+PCEA group,which was significantly longer than that of the nitrous oxide group,which were (43 3±21 4) minutes(P<0 01). Apgar score was higher in the CSEA+PCEA group than that in the nitrous oxide gro up (P<0 01).In the two groups that with different delivery mod es,the incidences of postpartum hemorrhage,fetal distress and neonatal asphyxia were similar (P>0 05)Conclusion CSEA with ropivacaine is safe and effective for labor analgesia.It should be performed in the medical units under optimal conditions.Inhaling nitrous oxide that premixed with oxygen is a useful alternative if the parturient refuses or is not indicat ed for combined spinal epidural analgesia.However analgesia is less satisfactor y.