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目的研究全产程硬膜外分娩镇痛的效果及对应激反应的影响。方法300例无产科并发症及硬膜外麻醉禁忌证的单胎足月初产妇,随机分为3组。Ⅰ组为全产程组,当进入产程宫口<3 cm时进行镇痛;Ⅱ组为活跃期组,当宫口≥3 cm时进行镇痛。两组硬膜外均给予0.1%罗哌卡因与0.5μg/ml舒芬太尼混合液11～13 ml,45 min后行硬膜外自控镇痛,药物为上述混合液,背景速度8 ml/h,单次剂量2 ml,锁定时间15 min。宫口开全时停药,胎儿娩出后再开启PCA;Ⅲ组为对照组,不用任何镇痛药物。观察VAS评分和运动阻滞分级,记录产程时间、分娩方式、产后出血量、新生儿Apgar评分。测定产妇血中血管紧张素Ⅱ和皮质醇含量。结果Ⅰ组与Ⅱ、Ⅲ组比较,在潜伏期VAS评分明显降低(P<0.05),Ⅰ、Ⅱ组与Ⅲ组比较,缩宫素使用率明显增高(P<0.05)。三组间比较产程时间、剖宫产率、器械助产率、产后出血量及新生儿Apgar评分比较差异无统计学意义(P>0.05)。Ⅲ组血管紧张素Ⅱ和皮质醇的变化最大,其次为Ⅱ组,Ⅰ组变化最小。结论全产程分娩镇痛对比传统分娩镇痛方式,镇痛效果确切,对产程、剖宫产率及新生儿并无不良影响,可抑制应激反应。
Objective To study the effect of full-term epidural labor analgesia and its effect on stress response. Methods 300 cases of unmarried women with obstetric complications and contraindications to epidural anesthesia were randomly divided into three groups. Group Ⅰ was the whole-work group, analgesia when entering the cervix <3 cm, group Ⅱ as the active group, and analgesia when the cervix was ≥3 cm. Both groups were given epidural ropivacaine 0.1% and 0.5μg / ml sufentanil mixture 11 ~ 13ml, 45min after epidural analgesia, the drug mixture, the background speed of 8ml / h, a single dose of 2 ml, locking time 15 min. Miyaguchi open all-time withdrawal, and then open the fetus after delivery of PCA; Ⅲ group for the control group, without any analgesic drugs. VAS scores and motor block scores were observed. The duration of labor, mode of delivery, postpartum hemorrhage, Apgar score of neonates were recorded. Determination of maternal blood angiotensin Ⅱ and cortisol content. Results Compared with group Ⅱ and group Ⅲ, the VAS score of group Ⅰ decreased significantly (P <0.05). Compared with group Ⅲ, group Ⅰ and Ⅱ increased the rate of oxytocin significantly (P <0.05). There were no significant differences among the three groups in comparison of labor duration, cesarean section rate, equipment birth rate, postpartum hemorrhage volume and neonatal Apgar score (P> 0.05). In group Ⅲ, the changes of angiotensin Ⅱ and cortisol were greatest, followed by group Ⅱ, while group Ⅰ had the least change. Conclusions Compared with the traditional labor analgesia and labor analgesia, labor analgesia during the whole delivery period has definite analgesic effect and no adverse effects on labor, cesarean section rate and newborn infants. It can inhibit the stress response.