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目的比较硬膜外分娩镇痛始于潜伏期与活跃期对母婴的影响。方法 2013年12月-2015年1月接受分娩镇痛的足月、单胎、头位初产妇80例,根据开始分娩镇痛的时机分为潜伏期(宫口扩张0.5~3.0cm)组(L组,n=40)和活跃期(宫口扩张>3.0cm)组(A组,n=40)。同时随机选取不接受分娩镇痛的足月、单胎、头位初产妇40例为对照组(C组)。A组和L组均以L2~3间隙进行硬膜外穿刺,以0.1%罗哌卡因+芬太尼(2μg/ml)5ml为试验剂量,随后注入上述药物10ml,硬膜外导管连接镇痛泵,药物同上,采用PCA模式,PCA量6ml,间隔时间30min。于镇痛前即刻(C组于宫口扩张3cm时)、镇痛开始后5、10、15、30min、宫口扩张7~8cm及10cm时行VAS评分,采用改良Bromage评分法测定下肢肌力。镇痛前取静脉血样,胎儿娩出即刻取母体静脉血样及脐带血样,采用放免法测定血浆皮质醇浓度,采用高效液相色谱法测定脐带血浆罗哌卡因浓度。记录镇痛时间、产程时间、分娩方式、催产素使用情况、药物用量、胎儿娩出后1、5min时Apgar评分、产妇满意度评分及不良反应发生情况。结果与C组比较,L组和A组镇痛开始后各时点VAS评分降低,胎儿娩出即刻母体血浆皮质醇浓度降低,第一产程时间缩短,催产素使用率升高,剖宫产率降低(P<0.05),其余指标差异无统计学意义(P>0.05)。与L组比较,A组镇痛时间缩短(P<0.05),其余指标差异无统计学意义(P>0.05)。3组间脐带血浆皮质醇浓度比较差异无统计学意义(P>0.05)。结论硬膜外分娩镇痛始于潜伏期与活跃期均能降低剖宫产几率,在其程度上无差异,且不延长产程,对新生儿同样安全。
Objective To compare the effects of epidural analgesia on maternal and infant in latent period and active period. Methods From December 2013 to January 2015, 80 full-term, single-born and first-born primiparae receiving labor analgesia were divided into two groups according to the timing of labor analgesia: 0.5 to 3.0 cm Group, n = 40) and active stage (cervix expansion> 3.0 cm) (group A, n = 40). At the same time, randomly selected 40 cases of full-term, single-child, head-born mothers who did not receive labor analgesia as the control group (C group). Epidural puncture was performed in L2 and L3 in group A and group L, with 5ml of 0.1% ropivacaine plus fentanyl (2μg / ml) as the test dose, followed by 10ml of the above drug, and epidural catheter connected to the town Pain pump, drug ibid, using PCA mode, PCA volume 6ml, interval time 30min. Immediately before the analgesia (C group in the cervix expansion 3cm), 5,10,15,30 min after the start of analgesia, cervical dilatation 7 ~ 8cm and 10cm when VAS score, improved Bromage score method for the determination of lower limb muscle strength . Venous blood samples were collected before analgesia. The maternal venous blood samples and cord blood samples were immediately taken from the fetus. Plasma cortisol concentration was determined by radioimmunoassay. The cord blood plasma ropivacaine concentration was determined by HPLC. The analgesic time, labor time, mode of delivery, oxytocin use, drug dosage, Apgar score at 1,5 min after fetus delivery, maternal satisfaction score and adverse reactions were recorded. Results Compared with group C, the VAS score decreased at each time point after analgesia in group L and group A, and the plasma cortisol level in maternal plasma decreased immediately after birth, the time of first stage of labor was shortened, the rate of oxytocin was increased, and the rate of cesarean section was decreased (P <0.05). There was no significant difference between the other indexes (P> 0.05). Compared with L group, the analgesic time of group A was shortened (P <0.05), while the other indexes had no significant difference (P> 0.05). Umbilical cord plasma cortisol levels between the three groups showed no significant difference (P> 0.05). Conclusion Epidural analgesia started in the incubation period and active phase can reduce the chance of cesarean section, no difference in its extent, and does not prolong the labor process, the same safety of the newborn.