中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2009年
1期
33-36
,共4页
耿志宇%吴新民%李萍%符莹莹
耿誌宇%吳新民%李萍%符瑩瑩
경지우%오신민%리평%부형형
镇痛%产科%镇痛%硬膜外%罗哌卡因%舒芬太尼
鎮痛%產科%鎮痛%硬膜外%囉哌卡因%舒芬太尼
진통%산과%진통%경막외%라고잡인%서분태니
Analgesia,obstetrical%Analgesia,epidural%Ropivacaine%Sufentani
目的 比较初产妇潜伏期和活跃期分娩镇痛的产程和分娩方式.方法 自愿接受分娩镇痛无产科及硬膜外阻滞禁忌证的单胎孕初产妇360例,按宫口扩张度分为两组.潜伏期组(L组):当宫口<3 cm时进行硬膜外穿刺,注入0.1%罗哌卡因和0.5μg/ml舒芬太尼混合液10～15 ml.活跃期组(A组):当官口≥3 cm时进行硬膜外穿刺,注入0.15%罗哌卡因和0.5μg/ml舒芬太尼混合液10～15 m1.两组PCA泵均采用0.1%罗哌卡因和0.5μg/ml舒芬太尼的混合液,按PCA 6 ml/15～20 min方式,由产妇自行给药,于分娩结束后停泵.结果 两镇痛组均可获得满意的镇痛效果,L组的剖宫产率高于A组(P<0.05),器械助产率低于A组(P<0.05).两组剖宫产的主要指征均是产程中活跃期停滞和胎儿窘迫.两组器械助产的主要指征均是胎儿窘迫,有30%的胎儿窘迫具有脐带绕颈因素.两组的第一产程和第二产程均无差异.两组新生儿出生结局良好.结论 镇痛提前至潜伏期后不影响产程进展,但是剖宫产率增加,器械助产率降低.
目的 比較初產婦潛伏期和活躍期分娩鎮痛的產程和分娩方式.方法 自願接受分娩鎮痛無產科及硬膜外阻滯禁忌證的單胎孕初產婦360例,按宮口擴張度分為兩組.潛伏期組(L組):噹宮口<3 cm時進行硬膜外穿刺,註入0.1%囉哌卡因和0.5μg/ml舒芬太尼混閤液10～15 ml.活躍期組(A組):噹官口≥3 cm時進行硬膜外穿刺,註入0.15%囉哌卡因和0.5μg/ml舒芬太尼混閤液10～15 m1.兩組PCA泵均採用0.1%囉哌卡因和0.5μg/ml舒芬太尼的混閤液,按PCA 6 ml/15～20 min方式,由產婦自行給藥,于分娩結束後停泵.結果 兩鎮痛組均可穫得滿意的鎮痛效果,L組的剖宮產率高于A組(P<0.05),器械助產率低于A組(P<0.05).兩組剖宮產的主要指徵均是產程中活躍期停滯和胎兒窘迫.兩組器械助產的主要指徵均是胎兒窘迫,有30%的胎兒窘迫具有臍帶繞頸因素.兩組的第一產程和第二產程均無差異.兩組新生兒齣生結跼良好.結論 鎮痛提前至潛伏期後不影響產程進展,但是剖宮產率增加,器械助產率降低.
목적 비교초산부잠복기화활약기분면진통적산정화분면방식.방법 자원접수분면진통무산과급경막외조체금기증적단태잉초산부360례,안궁구확장도분위량조.잠복기조(L조):당궁구<3 cm시진행경막외천자,주입0.1%라고잡인화0.5μg/ml서분태니혼합액10～15 ml.활약기조(A조):당관구≥3 cm시진행경막외천자,주입0.15%라고잡인화0.5μg/ml서분태니혼합액10～15 m1.량조PCA빙균채용0.1%라고잡인화0.5μg/ml서분태니적혼합액,안PCA 6 ml/15～20 min방식,유산부자행급약,우분면결속후정빙.결과 량진통조균가획득만의적진통효과,L조적부궁산솔고우A조(P<0.05),기계조산솔저우A조(P<0.05).량조부궁산적주요지정균시산정중활약기정체화태인군박.량조기계조산적주요지정균시태인군박,유30%적태인군박구유제대요경인소.량조적제일산정화제이산정균무차이.량조신생인출생결국량호.결론 진통제전지잠복기후불영향산정진전,단시부궁산솔증가,기계조산솔강저.
Objective To compare the outcome of ropivaeaine plus sufentanil for patient-controlled epidural analgesia between nulliparous women presenting in latent and active labor. Methods 360 nulliparous parturients were randomized according to cervix dilation. Latent group (cervix dilation < 3 cm) received 0.1% ropivacaine with 0.5 μg/ml sufentanil and active proup (cervix dilation≥3 cm) receive0.15% ropivaeaine with 0. 5 μg/ml sufcntanil, both followed by an infusion of 0.1% ropivaeaine with 0.5 μg/ml sufentanil through PCEA. The PCEA pump was programmed to infuse a 6 ml bolus with a lockout interval of 15-20 min. The following were recorded: (1) pain intensity evaluated using VAS (0-10), (2) motor block assessed using modified Bromage scale, (3) onset of analgesia after epidural injection, (4) fetal heart rate, (5) maternal vital signs, (6) apgar score, (7) labor process, (8) mode of delivery and (9) the total amount of analgesic consumed. Results Both groups provided good analgesia. Early administration of epidural analgesia did not prolong the duration of first and second stage of labor. However, group L had a significant higher caesarean section rate and a significant lower instrumental delivery rate than group A. The reasons of cesarean section in both groups were arrested active phase and fetal distress. The reasons of instrumental delivery in both groups were fetal distress. The neonates had good outcome in both groups. Conclusions Compared with epidural analgesia in active phase of labor, early administration of epidural analgesia in latent phase did not prolong labor, however, the caesarean section rate was increased and instrumental delivery rate was decreased.
