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目的探讨腰-硬联合与硬膜外阻滞麻醉两种不同给药方式在无痛分娩中镇痛效果及对产程和胎儿的影响。方法选择无麻醉禁忌证、无经阴道分娩禁忌且自愿接受无痛分娩的初产妇160例,平均分成4组,即非麻醉镇痛对照组为C组,硬膜外阻滞镇痛组为CEA组,腰-硬联合阻滞镇痛组为CSEA组(又分为CSEA-F组和CSEA-L组)。CEA组40例:0.125%盐酸罗哌卡因+2μg/ml芬太尼。CSEA-F组40例:蛛网膜下腔单次注射芬太尼25μg。CSEA-L组40例:蛛网膜下腔单次注射0.75%盐酸罗哌卡因3.75 mg。另外设置C组40例未接受麻醉镇痛分娩的初产妇。结果用药3组镇痛效果良好差异无统计学意义(P>0.05);CSEA-L组较CSEA-F、CEA组运动神经阻滞明显。第一产程蛛网膜下腔单次注射CSEA-F、CSEA-L组较CEA、C组明显延长,差异有统计学意义(P<0.05),CEA、C组间差异无统计学意义(P>0.05)。宫口开全时间、总产程和催产素使用量CSEA-F、CSEA-L组较CEA、C组明显增长或增多,差异有统计学意义(P<0.05),CEA、C组间差异无统计学意义(P>0.05)。4组新生儿1、5 min Apgar评分差异无统计学意义(P>0.05)。结论单纯持续硬膜外阻滞麻醉分娩镇痛较腰-硬联合阻滞麻醉分娩镇痛虽然起效较慢,但是镇痛效果良好,不影响运动及子宫收缩力,不增加催产素使用量,不影响母婴安全,且效果确切,操作简便,值得临床推广应用。
Objective To investigate the analgesic effects of two different administration modes of lumbar-hard and epidural anesthesia on painless delivery and its effects on labor and fetus. Methods 160 patients with no contraindications to vaginal delivery who were given painless childbirth were randomly divided into 4 groups. The CSEA group was divided into CSEA-F group and CSEA-L group. 40 cases of CEA group: 0.125% ropivacaine hydrochloride + 2μg / ml fentanyl. 40 cases of CSEA-F group: a single injection of fentanyl subarachnoid 25μg. CSEA-L group 40 patients: a single subarachnoid injection of 0.75% ropivacaine hydrochloride 3.75 mg. Another set of 40 cases of C group did not receive analgesia labor primipara. Results There was no significant difference in analgesic effect among the three groups (P> 0.05). Motor nerve block in CSEA-L group was more obvious than CSEA-F and CEA group. Compared with CEA and C group, CSEA-F group and CSA-L group were significantly prolonged in the first subarachnoid space of the first stage of labor and the difference was statistically significant (P <0.05). There was no significant difference between CEA and C group (P> 0.05). The total time of cervix opening, total labor and oxytocin use volume in CSEA-F and CSEA-L groups were significantly increased or increased compared with those in CEA and C groups (P <0.05), but there was no statistical difference between CEA and C groups Significance (P> 0.05). There was no significant difference in Apgar score between the 4 groups of newborns at 1,5 min (P> 0.05). Conclusions Simple epidural anesthesia for labor analgesia compared with lumbar-hard combined anesthesia labor analgesia although slow onset, but the analgesic effect is good, does not affect exercise and uterine contractility, do not increase the amount of oxytocin, Does not affect the safety of mother and child, and the exact effect, easy to operate, it is worth clinical application.