CAJ | 학술논문

目的比较双管法与单管法硬膜外分娩镇痛对胎头位置异常初产妇分娩结局的影响.方法接受硬膜外分娩镇痛的胎头位置异常的初产妇423例,单胎、足月,年龄20 ～ 35岁,体重70～90 kg,根据采用的硬膜外分娩镇痛方法,将其分为2组:双管法硬膜外分娩镇痛组(A组,n=206)和单管法硬膜外分娩镇痛组(B组,n=217),均由助产士指导其进行体位管理.A组产妇分别经T12-L1间隙头向、L4-L5或L5-S1间隙尾向置入硬膜外导管4 cm,上管注入镇痛混合液(0.1％盐酸罗哌卡因+0.5μg/ml舒芬太尼)4～6 ml,45 min后接PCEA泵(药物浓度同上,背景输注速率4 ml/h,PCA量2ml,锁定时间15 min),下管由麻醉科医生根据情况每次注入镇痛混合液4～6ml(在宫口近全时给药1次).B组产妇于L2-L3或L3-L4间隙头向置入硬膜外导管4 cm,注入上述镇痛混合液10～ 15 ml;45min后接PCEA泵(药物浓度同上,背景输注速率8 ml/h,PCA量2 ml,锁定时间15 min),2组均在宫口开全后PCEA泵停止给药.记录经阴道分娩产妇镇痛前宫口开大程度、第一产程、第二产程及第三产程的时间;记录胎位转复分娩和中转剖宫产的情况、器械助产和缩宫素使用情况、第一产程和第二产程孕妇镇痛满意情况;记录不同指征所致剖宫产的发生情况.结果与B组比较,A组经阴道分娩产妇第一产程、第二产程时间缩短,胎位转复分娩率、剖宫产率、器械助产使用率及缩宫素使用率降低,第二产程镇痛满意率升高(P＜ 0.05或0.01).结论双管法硬膜外分娩镇痛用于胎头位置异常初产妇的分娩结局优于单管法硬膜外分娩镇痛.
목적 비교쌍관법여단관법경막외분면진통대태두위치이상초산부분면결국적영향.방법 접수경막외분면진통적태두위치이상적초산부423례,단태、족월,년령20 ～ 35세,체중70～90 kg,근거채용적경막외분면진통방법,장기분위2조:쌍관법경막외분면진통조(A조,n=206)화단관법경막외분면진통조(B조,n=217),균유조산사지도기진행체위관리.A조산부분별경T12-L1간극두향、L4-L5혹L5-S1간극미향치입경막외도관4 cm,상관주입진통혼합액(0.1％염산라고잡인+0.5μg/ml서분태니)4～6 ml,45 min후접PCEA빙(약물농도동상,배경수주속솔4 ml/h,PCA량2ml,쇄정시간15 min),하관유마취과의생근거정황매차주입진통혼합액4～6ml(재궁구근전시급약1차).B조산부우L2-L3혹L3-L4간극두향치입경막외도관4 cm,주입상술진통혼합액10～ 15 ml;45min후접PCEA빙(약물농도동상,배경수주속솔8 ml/h,PCA량2 ml,쇄정시간15 min),2조균재궁구개전후PCEA빙정지급약.기록경음도분면산부진통전궁구개대정도、제일산정、제이산정급제삼산정적시간;기록태위전복분면화중전부궁산적정황、기계조산화축궁소사용정황、제일산정화제이산정잉부진통만의정황;기록불동지정소치부궁산적발생정황.결과 여B조비교,A조경음도분면산부제일산정、제이산정시간축단,태위전복분면솔、부궁산솔、기계조산사용솔급축궁소사용솔강저,제이산정진통만의솔승고(P＜ 0.05혹0.01).결론 쌍관법경막외분면진통용우태두위치이상초산부적분면결국우우단관법경막외분면진통.
Objective To compare double-versus single-catheter labor epidural analgesia for delivery outcomes of primiparae with abnormal fetal head position.Methods Four hundred and twenty-three primiparae who were at full term with a singleton fetus in abnormal fetal head position,aged 20-35 yr,weighing 70-90 kg,underwent labor epidural analgesia,were divided into 2 groups according to the method of labor epidural analgesia:double-catheter labor epidural analgesia group (group A,n =206) and single-catheter labor epidural analgesia group (group B,n =217).The body position management was performed under the guidance of the maternity nurse.The epidural catheter was placed at T12-L1 in the cephalad direction and at L4-L5 or L5-S1 in the caudal direction and advanced for 4 cm in the epidural space in group A.The analgesic mixture (0.1％ ropivacaine hydrochloride + 0.5 μg/ml sufentanil) 4-6 ml was injected through the upper catheter,and 45 min later the catheter was connected to a patient-controlled epidural analgesia (PCEA) pump (background infusion 4 ml/h,bolus dose 2 ml,lockout interval 15 min).A bolus dose of analgesic mixture 4-6 ml was injected through the lower catheter according to the condition.In group B,the epidural catheter was placed at L2-L3 or L3-L4 in the cephalad direction and advanced for 4 cm in the epidural space and the analgesic mixture mentioned above 10-15 ml was injected,and 45 min later the catheter was connected to a PCEA pump (background infusion 8 ml/h,bolus dose 2 ml,lockout interval 15 min).PCEA was stopped at complete cervical dilatation in the two groups.The dilatation of cervix before analgesia and length of labor in the parturients waiting for vaginal delivery were recorded.The successful delivery after fetal position changes,replacement of vaginal delivery with cesarean section,instrumental vaginal delivery,requirement for oxytocin,and parturients' satisfaction with the first and second stages of labor were recorded.Results Compared with group B,the first and second stages of labor were significantly shortened,the rate of successful delivery after fetal position changes,rate of cesarean section,instrumental vaginal delivery and requirement for oxytocin were decreased,and the parturients' satisfaction with the second stage of labor was increased in group A (P ＜ 0.05).Conclusion Double-catheter labor epidural analgesia provides better delivery outcomes of primiparae with abnormal fetal head position than single-catheter labor epidural analgesia.