硬膜外联合蛛网膜下腔阻滞麻醉用于分娩镇痛213例临床分析.docVIP

硬膜外联合蛛网膜下腔阻滞麻醉用于分娩镇痛213例临床分析【摘要】 目的 探讨硬膜外联合蛛网膜下腔阻滞麻醉应用于分娩镇痛对产程、分娩方式、母婴合并症的影响。方法 选择采用蛛网膜下腔联合硬膜外阻滞麻醉（CSEA）的单胎、初产、足月、无其他合并症的产妇213例作为试验组，随机选择同期条件相似，未进行任何镇痛处理的产妇213例作为对照组。分别记录两组的产程时间、新生儿体重、剖宫产和阴道助产指征、胎儿宫内窘迫、新生儿窒息、产后出血、胎膜残留、尿潴留情况。结果 镇痛后A组的第一产程活跃期和第二产程均缩短（P＜0.05），与B组比较有显著性差异。第一产程潜伏期、第三产程和总产程两组比较无显著性差异（P＞0.05）。结论 分娩镇痛与非镇痛比较可使第一产程活跃期和第二产程缩短，不影响总产程，不增加剖宫产和阴道助产几率，对母婴均较为安全。 【关键词】 硬膜外联合蛛网膜下腔阻滞麻醉； 分娩镇痛 Clinical analysis of 213 cases combined spinal epidural anesthesia for labor analgesia LIU Hong,HOU Tie-jun,CHEN Ji-en,CHEN Pei-hua.Guangdong Changping Hospital of Dongguan, Dongguan 523573,China 【Abstract】 Objective To discuss the impact of epidural spinal anesthesia used in labor analgesia on labor, delivery mode, maternal complications.Methods 213 maternals with single child, the beginning of production, full-term, no other complications were selected as pilot group, treated with spinal anesthesia combined with epidural anesthesia （CSEA） for labor analgesia .213 cases of similar conditions and same period were randomly selected as control group, without any analgesic treatment. Labor duration, birth weight, cesarean section and vaginal delivery indications, fetal distress, neonatal asphyxia, postpartum hemorrhage, fetal membranes residue and urinary retention were recorded ,respectively.Results A group of first analgesic products after the active stage and second stage of labor were shortened （P0.05）.Conclusion Analgesia compared with non-analgesic active phase of labor can make the first and the second stage of labor reduced, does not affect the total process, without increasing the risk of caesarean section and vaginal delivery, the mother and child are safer. 【Key words】 Combined spinal epidural anesthesia; Labor analgesia 分娩疼痛是伴随分娩过程中阵发性宫缩的剧烈疼痛。长时间的疼痛严重影响产妇的情绪，消耗体力。产程延长、胎儿窘迫等因素使剖宫产率增高。近年来，如何为产妇提供安全舒适的、至少是能够耐受的镇痛方法，使产妇能顺利分娩受到了越来越多的关注。笔者所在医院2009年1月～2010年12月开展了CSEA分娩镇痛法镇痛分娩213例产妇，取得了较好的效果，总结分析CSEA用于分娩镇痛对于产程、分娩方式、母婴合并症等的影响，现报告如下。 1 资料与方法 1.1 一般资料 选择笔者所在医院200