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目的:探讨腰硬联合麻醉(combined spinal and epidural anesthesia,CSEA)减轻或消除产痛以及对产程、胎儿、分娩方式的影响。方法:选择60例无产科、麻醉禁忌证的初产妇(观察组),在宫口开大2~3 cm时,给予腰麻联合硬膜外麻醉,并与同期条件相似、未给予任何镇痛方法的60例初产妇进行对照(对照组)。比较两组产痛程度、产程进展速度、分娩方式及对胎儿的影响。结果:观察组镇痛有效率较对照组明显升高(P<0.01)。观察组活跃期较对照组缩短,宫颈扩张速度加快、剖宫产率下降,经阴道助产分娩率增高(P<0.05)。胎儿窘迫及新生儿窒息、产后出血发生率两组比较,差异均无显著性(P>0.05)。结论:CSEA应用于产科,可达到分娩镇痛、加速产程、降低剖宫产率的作用,对胎儿无不良影响,值得推广应用。
Objective: To investigate the effects of combined spinal and epidural anesthesia (CSEA) on reducing or eliminating labor pain, labor, fetus and mode of delivery. Methods: A total of 60 primiparae with obstetric and anesthesia contraindications (observation group) were selected. When the cervix was opened 2 to 3 cm, spinal anesthesia and epidural anesthesia were given. Similar to the same period, no analgesia was given Methods 60 cases of primipara were compared (control group). The level of labor pain, the rate of labor progress, the mode of delivery and the impact on the fetus were compared between the two groups. Results: The analgesic effective rate in the observation group was significantly higher than that in the control group (P <0.01). The active phase of the observation group was shorter than that of the control group, the cervical dilatation speed was accelerated, the cesarean section rate was decreased, and the transvaginal delivery rate was increased (P <0.05). Fetal distress and neonatal asphyxia, the incidence of postpartum hemorrhage between the two groups, the difference was not significant (P> 0.05). Conclusion: CSEA can be used in obstetrics to achieve analgesia during childbirth, accelerate labor process and reduce cesarean section rate. It has no adverse effect on fetus and should be popularized and applied.