CAJ | 학술논문

目的：研究分娩产妇运用硬膜外阻滞和蛛网膜下腔阻滞联合麻醉对产妇分娩方式、新生儿近期合并症以及产程中宫缩情况的影响。方法选择2012年5月~2013年5月于浙江省丽水市妇幼保健院分娩的400例产妇为研究对象，将其分为观察组(n=216)和对照组(n=184)。观察组患者运用硬膜外阻滞和蛛网膜下腔阻滞联合麻醉，对照组患者未实施分娩镇痛。对两组产妇及新生儿情况进行比较，观察两组产妇的产程时间、分娩方式、产妇和新生儿合并症及产程中宫缩素使用情况。结果观察组的216例患者中，44例实施了剖宫产，占24.07%；对照组的184例患者中，76例实施了剖宫产，占41.30%，两组比较差异有统计学意义(P<0.05)。观察组中，44例实施产钳助产，占20.37%；对照组中12例，占6.52%；两组比较差异有统计学意义(P<0.05)。观察组中，120例阴道顺产，占55.56%，对照组中阴道顺产94例，占51.09%；观察组中64例使用缩宫素，占29.63%，对照组中18例，占9.78%，两组比较差异均有统计学意义(P<0.05或P<0.01)。观察组活>期延长、胎儿窘迫以及第二产程延长发生率分别为3.70%、32.41%、6.48%；对照组中分别为1.09%、28.26%、3.26%，两组比较，差异均有高度统计学意义(P<0.01)；观察组产后出血以及新生儿窒息的发生率分别为4.63%、29.63%，对照组为3.26%、9.78%，两组比较差异均有统计学意义(P<0.05)。结论在产程中对产妇实施硬腰联合麻醉镇痛分娩，能够有效地降低剖宫产率，但是会引起产钳助产率升高，分娩镇痛与第二产程延长、活>期延长有一定关系，但是不会使产后出血及新生儿窒息的发生概率增加。腰-硬联合麻醉对分娩产妇实施分娩镇痛不会对产妇及新生儿产生不良反应，可以放心在临床上应用。
목적：연구분면산부운용경막외조체화주망막하강조체연합마취대산부분면방식、신생인근기합병증이급산정중궁축정황적영향。방법선택2012년5월~2013년5월우절강성려수시부유보건원분면적400례산부위연구대상，장기분위관찰조(n=216)화대조조(n=184)。관찰조환자운용경막외조체화주망막하강조체연합마취，대조조환자미실시분면진통。대량조산부급신생인정황진행비교，관찰량조산부적산정시간、분면방식、산부화신생인합병증급산정중궁축소사용정황。결과관찰조적216례환자중，44례실시료부궁산，점24.07%；대조조적184례환자중，76례실시료부궁산，점41.30%，량조비교차이유통계학의의(P<0.05)。관찰조중，44례실시산겸조산，점20.37%；대조조중12례，점6.52%；량조비교차이유통계학의의(P<0.05)。관찰조중，120례음도순산，점55.56%，대조조중음도순산94례，점51.09%；관찰조중64례사용축궁소，점29.63%，대조조중18례，점9.78%，량조비교차이균유통계학의의(P<0.05혹P<0.01)。관찰조활>기연장、태인군박이급제이산정연장발생솔분별위3.70%、32.41%、6.48%；대조조중분별위1.09%、28.26%、3.26%，량조비교，차이균유고도통계학의의(P<0.01)；관찰조산후출혈이급신생인질식적발생솔분별위4.63%、29.63%，대조조위3.26%、9.78%，량조비교차이균유통계학의의(P<0.05)。결론재산정중대산부실시경요연합마취진통분면，능구유효지강저부궁산솔，단시회인기산겸조산솔승고，분면진통여제이산정연장、활>기연장유일정관계，단시불회사산후출혈급신생인질식적발생개솔증가。요-경연합마취대분면산부실시분면진통불회대산부급신생인산생불량반응，가이방심재림상상응용。
Objective To study the effects of using of epidural anesthesia and spinal anesthesia on mode of delivery , neonatal complications and contractions in the birth process . Methods 400 cases of maternal from May 2012 to May 2013 in Maternal and Child Health Hospital Lishui City were selected as study objects, and they were divided into two groups, 216 patients in the observation group were given the epidural anesthesia and spinal anesthesia, 184 patients of the control group were not implemented analgesia. The maternal and neonatal conditions of two groups were compared, maternal labor time, mode of delivery, maternal and neonatal complications and birth process oxytocin usage of two groups were observed. Results Among 216 patients in the observation group, there were 44 cases of cesarean, account-ing for 24.07%, among 184 patients in the control group, 76 cases of cesarean, accounting for 41.30%, the difference of two groups were statistically significant (P< 0.05). There were 44 cases were forceps delivery in the observation group, accounting for 20.37%; and 12 cases in the control group, accounting for 6.52%; the difference of two groups were sta-tistically significant (P<0.05). There were 120 cases of spontaneous vaginal delivery in the observation group, account-ing for 55.56%; and 94 cases of the control group, accounting for 51.09%. 64 cases were given the oxytocin in the ob-servation group, accounting for 29.63%, and 18 cases in the control group were given the oxytocin, accounting for 9.78%, the differences of two groups were statistically significant (P< 0.05 or P< 0.01). The incidence of prolonged active phase, fetal distress and prolonged second stage the observation group were 3.70%, 32.41% and 6.48% respec-tively; and those in the control group were 1.09%, 28.26%, 3.26% respectively, the differences of two groups were sta-tistically significant (P< 0.01). The incidence of post-partum hemorrhage and neonatal asphyxia in the ob-servation group were 4.63%and 29.63%, in the control group were 3.26% and 9.78%, the differences of two groups were statistically significant (P< 0.05). Conclusion Waist joint anesthesia analgesia childbirth can effectively reduce the rate of cesarean section, but will cause forceps midwifery rate increases, labor analgesia and prolonged sec-ond stage, prolonged active phase, but not increase the risk of postpartum hemorrhage and neonatal asphyxia. Waist joint anesthesia analgesia for childbirth puerperal childbirth analgesia not on maternal and neonatal adverse reaction, can be at ease in clinical application.