分娩镇痛进展课件.pdfVIP

分娩镇痛进展 天津医科大学总医院 王国林 2006-4 合肥 • 1847年苏格兰产科医生Simpson J给分娩产 妇吸入乙醚以缓解疼痛，得出的印象是药 物可以缓解分娩痛，但同时要关注其副作 用，包括对子宫收缩、腹部肌张力以及对 胎儿的影响 • Epidural analgesia in labour is used by about 100 000 women in Britain each year BMJ 2002;325:357 分娩痛产生的机制 理想的分娩镇痛 • dramatically reduce the pain of labour, while allowing the parturient to actively participate in the birthing experience. • In addition, it should have minimal effect on the fetus or the progress of labour Regional analgesia for labour • spinal opiates and combined spinal- epidural (CSE) analgesia • patient controlled epidural analgesia • continuous spinal analgesia • neuraxial blockade (epidural, spinal, CSE, continuous spinal) provides the most effective and least depressant analgesia • Epidural analgesia via a catheter technique provides excellent pain relief and the ability to extend the duration of the block to match the duration of labour, but it is not instant in onset and may be associated with motor block. • One-shot spinal analgesia using a lipid soluble opioid is rapid and simple, but is associated with a limited duration of action • The combination of epidural and spinal anesthesia into one technique, termed CSE provides the advantages of a spinal (speed of onset, lack of motor block) with the additional flexibility of renewal with an epidural catheter. • CSE can be safely used to provide labour analgesia in parturients who are to receive an epidural for labour • specific patients who will greatly benefit from this technique. These include patients in early or late labour • early labour can be made comfortable with spinal narcotics (such as sufentanil or fentanyl) which will last for approximately two to three hours, during which time the patient will not have a motor blo