CAJ | 학술논문

目的：探讨自控腰硬联合分娩镇痛麻醉下，初产妇分娩过程中不同的停泵时机对产程、分娩结局和产妇满意度的影响。方法选择2013年4月~2013年12月间符合条件的初产妇120例，按先后顺序分到A、B、C三组，每完成10个另起一组，每组40例，腰硬联合麻醉分娩镇痛，A组宫口开全停泵，不再开泵；B组宫口开全停泵，胎儿娩出后立即开泵；C组一、二、三产程持续镇痛，三组均于第三产程结束，会阴缝合术毕结束镇痛并拔硬外镇痛管。观察比较产妇基本情况、镇痛效果（VAS）评分、第1、2、3产程时间、产后2h内出血量、缩宫素使用、剖宫产率、钳产率、羊水性质、产妇满意度，新生儿Apgar评分。结果三组间产后2h出血、新生儿Apgar评分、第三产程时间差异无统计学意义；A、B组产妇分娩痛比例较C组增加，会阴缝合痛或不适者较C组多，C组产妇满意度较A、B组增加，差异有统计学意义，A、B组间各项指标间差异无统计学意义。结论不同的停泵时机不增加第二产程，不影响新生儿Aparg评分，不增加产后出血，持续用药组增加缩宫素使用率，差异有统计学意义（P＜0.05），可能增加剖宫产趋势，但可提高产妇满意度。
목적：탐토자공요경연합분면진통마취하，초산부분면과정중불동적정빙시궤대산정、분면결국화산부만의도적영향。방법선택2013년4월~2013년12월간부합조건적초산부120례，안선후순서분도A、B、C삼조，매완성10개령기일조，매조40례，요경연합마취분면진통，A조궁구개전정빙，불재개빙；B조궁구개전정빙，태인면출후립즉개빙；C조일、이、삼산정지속진통，삼조균우제삼산정결속，회음봉합술필결속진통병발경외진통관。관찰비교산부기본정황、진통효과（VAS）평분、제1、2、3산정시간、산후2h내출혈량、축궁소사용、부궁산솔、겸산솔、양수성질、산부만의도，신생인Apgar평분。결과삼조간산후2h출혈、신생인Apgar평분、제삼산정시간차이무통계학의의；A、B조산부분면통비례교C조증가，회음봉합통혹불괄자교C조다，C조산부만의도교A、B조증가，차이유통계학의의，A、B조간각항지표간차이무통계학의의。결론불동적정빙시궤불증가제이산정，불영향신생인Aparg평분，불증가산후출혈，지속용약조증가축궁소사용솔，차이유통계학의의（P＜0.05），가능증가부궁산추세，단가제고산부만의도。
Objective To explore the effects of different time of stopping pumping on stages of labour, delivery outcomes and parturients' satisfaction during delivery of primiparas who received self-controlled combined spinal-epidural anaesthesia for labour analgesia. Methods 120 eligible primiparas who were admitted from April 2013 to December 2013 were selected and assigned to group A, B and C according to admission order. Every ten people were assigned to each group once a time. Each group had 40 primiparas and received combined spinal-epidural labour analgesia. Pumping was stopped when cervix was wide open for group A and never restarted; pumping was stopped when cervix was wide open for group B, and restarted immediately after delivery; group C kept receiving labour analgesia all the way through the first, second and third stages. All three groups terminated analgesia at the third stage. The analgesia was terminated after perineorrhaphy and tubes for epidural analgesia were removed. Basic conditions of parturients, VAS scores, durations of the first, second and third stages, amount of bleeding in two hours after delivery, use of oxytocin, rate of caesarean section, rate of delivery by pliers, quality of amniotic fluid, satisfaction rate of parturients and Apgar scores were observed and compared. Results No differences of amount of bleeding in two hours after delivery, Apgar scores, and durations of the third stages were detected between the three groups;ratios of labour pain for parturients in group A and B were higher than those in group C, and the number of parturients who encountered pain during perineorrhaphy or felt uncomfortable was higher than that in group C. The satisfaction rate in group C was higher than that in group A and B, and the differences were statistically significant. No statistically significant differences of indices between group A and B were seen. Conclusion Different time of stopping pumping does not prolong the second stage, does not affect Apgar scores or exacerbate postpartum haemorrhage. Application rate of oxytocin increases in the group which receives continued analgesia (P<0.05), and the difference is statistically significant. Continued analgesia may promote the trend of caesarean section, yet improves parturients’satisfaction rate.