病人自控硬膜外镇痛用于分娩镇痛的临床评价

A clinical evaluation on labor analgesia used patient control extradural anesthesia

目的 :探讨病人自控硬膜外镇痛 (PatientControlExtraduralAnalgesia ,PCEA)在减轻或消除分娩疼痛以及对产程、胎儿、分娩方式的影响。方法 :选择 2 0 5例无产科及麻醉禁忌症的初产妇为实验组 ,在产程进入活跃早期宫口开大 2 .5～ 3cm时 ,给予自控硬脊膜外麻醉 ;选择同期条件相似、未施予任何镇痛方法的 2 0 0例初产妇为对照组。观察硬脊膜外阻滞麻醉的镇痛效果及两组产程进展情况、分娩方式、新生儿Agpar评分、产时失血量及产后出血。结果 :实验组分娩时疼痛程度为 0级、I级所占比例明显高于对照组 (P <0 .0 1) ,且活跃期较对照组明显缩短 ,宫颈扩张速度加快 ,但经阴道分娩助产率增高 (P <0 .0 5 ) ;胎儿宫内窘迫及新生儿窒息、产时失血量、产后出血发生率两组则无显著性差异 (P>0 .0 5 )。结论 :PCEA分娩镇痛效果可靠 ,可明显减轻分娩疼痛、加速产程进展 ,且对胎儿及产妇无不良影响 ,值得临床推广应用。

Objective: To investigate the effect of patient control extradural anesthesia (PCEA) on relieving and eliminating labor pain and the effect on newborns, labor process and delivery mode. Methods: 205 cases without any obstetric and anesthetic contraindications were selected for the study group, PCEA was applied when cervix dilated for about 2.5～3cm, 200 pregnant women with similar obstetric condition as control group without any anesthesia. Compare the labor pain, duration delivery mode and fetal status of two groups. Results: In study group, the proportion which the labor pain degrees are 0 and I were significantly more than that in control group(P<0.01)and showed good effect on relieving labor pain, shortening the active phase of labor course and acceleration of cervical dilation but increased in the rate of accouche through vaginal delivery(P<0.05). There were no significantly different in the incidence of fetal distress, neonatal asphyxia and postpartum hemorrhage between two groups(P>0.05). Conclusion: The PCEA is useful in relieving labor pain and accelerating labor course without any side effect on fetus and lying-in women and should be extended in clinic.