全产程腰-硬联合阻滞分娩镇痛临床应用.docVIP

全产程腰-硬联合阻滞分娩镇痛临床应用【摘 要】 目的:探讨全产程腰-硬联合阻滞分娩镇痛的可行性。方法:选择初产妇60例,分两组,A组(全产程组,宫口开张1～1.5cm)和B组(活跃期组,宫口开张2～3cm),每组30例。两组均采用蛛网膜下腔给药后硬膜外腔留管产妇自控镇痛(CSE+PCA),两组的蛛网膜下腔给药和硬膜外腔维持用药相同。观察记录镇痛时间、镇痛起效时间、不同时间的VAS评分、运动阻滞、各组产程、出血量、新生儿Apgar评分、镇痛满意度、分娩方式、不良反应等指标。结果:A组潜伏期时间短于B组(P0.05)。结论:全产程腰-硬联合阻滞分娩镇痛效果确切,不良反应少,可缩短产程,对产妇和新生儿无不良影响。? 【关键词】 全产程 分娩镇痛 蛛网膜下腔 硬膜外腔 舒芬太尼 Clinical application of whole production process combined spinal-epidural block analgesia? Zhou Chaoming,et al? 【Abstract】 Objective: To study the feasibility of combined spinal-epidural anesthesia (CSEA) for entire delivery analgesia. Method:Sixty primiparas were selected and divided into two groups: group A (entire delivery group with cervix opening for about 1cm) and group B (active period group with cervix opening for about 2~3cm), with each of these groups own 30 samples. Both of the two groups apply combined spinal epidural anesthesia and patient-controlled analgesia methods (CSE+PCA) with the amount of subarachnoid and epidural anesthesia maintain at the same level. The following variables are recorded during the observation: analgesia time, analgesic onset time, VAS score at different times, motor block, delivery period of each group, amount of bleeding, neonatal Apgar score, analgesic satisfaction, delivery mode, adverse reactions, etc. Results:The latent period for group A is shorter than group B (P0.05). Conclusions:The effect of CSEA is positive - it seldom has side effect, can shorten the delivery period, and has no adverse effect on puerperas and newborns.? 【Key words】 Entire delivery Delivery analgesia Subarachnoid Epidural Sufentanil 分娩导致许多妇女剧烈的痛苦。对于椎管内阻滞分娩镇痛,许多报道都推荐从活跃期开始应用。而之前的潜伏期(从规律宫缩到宫口开至3cm)短则几十分钟,长则数小时(初产妇平均8h)。因此,多数产妇需忍受潜伏期较长时间的疼痛。本研究探讨全产程腰-硬联合阻滞分娩镇痛的可行性。 1 资料与方法? 1.1 一般资料。自2008年10月~2009年2月,于我院住院与待产的初产妇中选择22~30岁、身高155~175cm、体重55~80kg、ASAⅠ~Ⅱ级,无椎管内麻醉禁忌症,无明显产科病理因素,足月头位单胎拟行阴道分娩的60例。分两组,每组30例。产妇自愿选择本研究的分娩镇痛的两种方法中的一种方法并签分娩镇痛知情同意书。A组(全产程组,宫口开张1~1.5cm);B组(活跃期组,宫口开张2~3cm)。 ? 1.2 镇痛方法。两组均采用蛛网