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目的探讨自控硬膜外镇痛(PCEA)结合导乐氏陪伴分娩在自然分娩中的应用价值。方法以2012年6月至2013年7月拟行自然分娩足月妊娠的235例孕妇为研究对象,均为头位单胎、无产科高危因素(妊娠期糖尿病、妊娠期高血压疾病、妊娠期肝内胆汁淤积症、妊娠合并心脏病等相关病理妊娠患者)、无麻醉及阴道分娩禁忌症。其中135例行单纯导乐氏陪伴分娩心理镇痛为A组;100例采用低浓度罗哌卡因复合芬太尼产妇自控微电脑程控泵硬膜外神经阻滞结合导乐氏陪伴分娩镇痛为B组;对比两组分娩镇痛效果、产程时间、剖宫产率、产后出血量、新生儿窒息发生率等相关指标。结果 B组患者治疗有效率达到98.00%,明显高于B组阵痛有效率17.03%,差异有统计学意义(P<0.05);两组产程时间,包括活跃期、第二产程、第三产程及总产程时间相比差异无统计学意义(P>0.05);两组孕妇产后出血及新生儿窒息的发生率相比差异无统计学意义(P>0.05),A组剖宫产率为31.85%,明显高于B组25.00%,差异有统计学意义(P<0.05)。结论低浓度罗哌卡因复合芬太尼用于减轻孕产妇分娩疼痛的一种方法,镇痛效果较传统方法好,对胎儿无明显毒副作用,安全可靠,值得临床推广应用。
Objective To investigate the value of self-controlled epidural analgesia (PCEA) combined with dural parole in spontaneous delivery. Methods A total of 235 pregnant women with full-term spontaneous labor during the period of June 2012 to July 2013 were selected as the study subjects. All of them were the first single births with no obstetric risk factors (gestational diabetes mellitus, gestational hypertension, pregnancy Intrahepatic cholestasis, pregnancy-related heart disease and other related pathological pregnancy patients), no anesthesia and contraindications of vaginal delivery. Among them, 135 patients underwent simple Doraemon with psychological analgesia during childbirth were Group A. 100 patients with low concentration of ropivacaine combined with fentanyl-controlled PC-controlled pump combined with epidural block and dural analgesia Group B; compared two groups analgesia effect, labor time, cesarean section rate, postpartum hemorrhage, neonatal asphyxia incidence and other related indicators. Results The effective rate of treatment in group B was 98.00%, which was significantly higher than that in group B (17.03%), the difference was statistically significant (P <0.05). The duration of labor, including the active stage, the second stage of labor, the third stage of labor, (P> 0.05). There was no significant difference in the incidence of postpartum hemorrhage and neonatal asphyxia between two groups (P> 0.05), and the rate of cesarean section in group A was 31.85% , Significantly higher than 25.00% in group B, the difference was statistically significant (P <0.05). Conclusion Low concentration of ropivacaine combined with fentanyl for relieving pain during delivery of pregnant women has a better analgesic effect than traditional methods and has no obvious toxic and side effects on the fetus. It is safe and reliable and worthy of clinical application.