硬脊膜外自控镇痛分娩与自然分娩的比较

目的 :探讨微泵法硬脊膜外阻滞镇痛法在产时镇痛中的应用价值。方法 :选择 60例足月单胎、初产、头位 ,估计可阴道分娩的健康孕妇 ,根据自愿的原则 ,每组 3 0例 ,分为微泵法硬脊膜外自控镇痛分娩组及自然分娩组 ,进行配对研究。观察两组产程、分娩时间、无痛分娩的效果及硬脊膜外自控镇痛对母儿的影响。结果 :镇痛组显效 2 6例 ( 86.7% ) ,有效 4例( 13 .3 % ) ,产时疼痛可有效地缓解 ,而两组的分娩方式、产后出血、胎儿窘迫等方面无显著性差异。结论 :微泵法硬脊膜外阻滞镇痛法用于分娩镇痛 ,效果产生迅速、可靠 ,对母、婴无不良影响。

导乐联合硬膜外分娩镇痛对初产妇镇痛效果及分娩方式的影响

目的探究导乐联合硬膜外分娩镇痛对初产妇镇痛效果及分娩方式的影响。方法选取2019年3月~2020年2月在我院分娩的125例初产妇,根据干预方案的不同进行分组,采用硬膜外分娩镇痛的62例初产妇设为对照组,将采用导乐联合硬膜外分娩镇痛的63例初产妇设为观察组,比较两组镇痛效果和分娩方式。结果治疗后,观察组VAS评分显著低于对照组,差异有统计学意义(P<0.05);观察组自然分娩率高于对照组,剖宫产率低于对照组,差异有统计学意义(P<0.05);胎儿娩出后1min,观察组新生儿Apgar评分明显高于对照组,差异有统计学意义(P<0.05)。结论 导乐联合硬膜外分娩镇痛可增加初产妇的镇痛效果,提高自然分娩率,且可提升新生儿Apgar评分,应用效果较好。

右美托咪定联合利多卡因硬膜外分娩镇痛对母婴结局及血清ALD、NE、Cor的影响

目的探究右美托咪定联合利多卡因硬膜外分娩镇痛对母婴结局及血清醛固酮(ALD)、去甲肾上腺素(NE)、皮质醇(Cor)的影响。方法选取行硬膜外分娩镇痛的240例产妇,将其按照随机数字表法分为联合组和单一组,各120例。其中单一组给予1%利多卡因硬膜外镇痛,联合组给予右美托咪定联合1%利多卡因硬膜外镇痛。比较两组血清ALD、NE、Cor水平,产程时间,疼痛程度,分娩结局及母婴结局。结果宫口开全、胎儿娩出时联合组血清ALD、NE、Cor水平与单一组比较均明显降低(P<0.05),第一、二、三产程时间与单一组比较均明显缩短(P<0.05)。干预后,两组产妇VAS评分与干预前相比均明显降低(P<0.05),且联合组与单一组比较明显降低(P<0.05)。联合组阴道分娩率91.67%与单一组70.83%比较明显升高(P<0.05),阴道助产率、剖宫产率、新生儿不良结局发生率及产妇不良结局发生率分别为6.67%、1.67%、0.00%、1.67%与单一组20.83%、8.33%、6.67%、8.33%比较均明显降低(P<0.05)。结论右美托咪定联合利多卡因硬膜外镇痛可有效降低产妇血清ALD、NE、Cor水平,抑制应激反应,缩短产程,改善母婴结局及分娩结局,值得临床推广使用。

改良硬脊膜穿破硬膜外阻滞技术在分娩镇痛中的应用

目的观察改良硬春膜穿破硬膜外阻滞技术在分娩鎮痛中的有效性与安全性。方法150例初产妇随机分为硬膜外镇痛组(E组)、改良硬脊膜穿破硬膜外镇痛组(D组)和腰硬联合镇痛组(C组),各50例。E组:硬膜外腔直接注入负荷药量;D组:硬膜外穿刺成功后,暂不给药,用27G腰麻针反复穿破硬脊膜4次,再往硬膜外腔注入负荷药量;C组:穿刺成功后蛛网膜下腔注入25μg芬太尼。三组维持.量用药方案相同。记录分娩镇痛前(T0)、镇痛后10min(TI)、镇痛后20 min(T2)、宫口开全时(T3)疼痛视觉模拟评分(VAS)、自控镇痛(PCA)按压次数;统计缩宫素使用率和瘙痒发生率。结果与E组和C组比较,D组在T3时VAS评分、自控按压次数均更低,差异有统计学意义(P<0.01)。相比E组和D组,C组瘙痒发生率、一过性胎心下降发生率和缩宫素使用率更高,差异有统计学意义(P<0.05)。结论相比硬膜外分娩镇痛和腰硬联合分娩镇痛,改良硬脊膜穿破硬膜外分娩镇痛不但安全有效,能在产程后期提供更好的骶尾部阻滞,且并发症较少。

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas:A cross-sectional study

Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.