CAJ | 학술논문

目的探讨椎管内麻醉及导乐仪等分娩镇痛方法在分娩产妇中的应用价值。方法选择本院住院分娩的正常足月且产妇无头盆不称等高危因素产妇364例，根据患者意愿分为三组：选择椎管内麻醉的产妇122例为椎管组，选择导乐仪的118例为导乐仪组，不用分娩镇痛的124例为对照组。观察产妇的镇痛效果、分娩方式、产程时间、新生儿评分、产后出血量。结果导乐仪组阴道平产率54．23％（64／118），高于椎管组42．62％（52／122）和对照组41．12％（51／124）（ P ＜0．05）；阴道助产率椎管组为24．59％（30／122），高于导乐仪组14．41％（17／118）和对照组14．52％（18／124）（ P ＜0．05）；对照组剖宫产率为44．35％（55／124），高于椎管组32．80％（40／122）和导乐仪组31．36％（37／118）（ P＜0．05）。导乐仪组的第一产程活跃期及第二产程时间分别为（105．35±31．55）min和（39．11±16．34）min ，均短于椎管组（163．42±33．2） min、（50．06±19．39） min和对照组（331．25±35．40）min、（87．96±31．50）min （ P ＜0．05），椎管组的第一产程活跃期及第二产程时间均短于对照组（P ＜0．05）。椎管组平均VAS评分为3．01±0．87，低于导乐仪组4．24±0．91和对照组6．13±1．03，且乐仪组低于对照组（P ＜0．05）。结论椎管内麻醉及导乐仪分娩镇痛疗效满意，促进自然分娩，降低了剖宫产率，对母婴无不良影响。
목적 탐토추관내마취급도악의등분면진통방법재분면산부중적응용개치。방법 선택본원주원분면적정상족월차산부무두분불칭등고위인소산부364례，근거환자의원분위삼조：선택추관내마취적산부122례위추관조，선택도악의적118례위도악의조，불용분면진통적124례위대조조。관찰산부적진통효과、분면방식、산정시간、신생인평분、산후출혈량。결과 도악의조음도평산솔54．23％（64／118），고우추관조42．62％（52／122）화대조조41．12％（51／124）（ P ＜0．05）；음도조산솔추관조위24．59％（30／122），고우도악의조14．41％（17／118）화대조조14．52％（18／124）（ P ＜0．05）；대조조부궁산솔위44．35％（55／124），고우추관조32．80％（40／122）화도악의조31．36％（37／118）（ P＜0．05）。도악의조적제일산정활약기급제이산정시간분별위（105．35±31．55）min화（39．11±16．34）min ，균단우추관조（163．42±33．2） min、（50．06±19．39） min화대조조（331．25±35．40）min、（87．96±31．50）min （ P ＜0．05），추관조적제일산정활약기급제이산정시간균단우대조조（P ＜0．05）。추관조평균VAS평분위3．01±0．87，저우도악의조4．24±0．91화대조조6．13±1．03，차악의조저우대조조（P ＜0．05）。결론 추관내마취급도악의분면진통료효만의，촉진자연분면，강저료부궁산솔，대모영무불량영향。
Objective] To explore the application value of labor analgesia with intraspinal anesthesia and DOU‐LA instrument in maternal delivery .[Methods]Totally 364 pregnant women with single birth and normal full term and without high‐risk factors such as cephalopelvic disproportion in our hospital were chosen .According to the will , all pregnant women were divided into 3 groups .Among them ,122 pregnant women with intraspinal anesthesia were selected as spinal group ,and 118 pregnant women with DOULA instrument were selected as DOULA instrument group ,and 124 pregnant women without labor analgesia were selected as control group .The analgesia efficacy ,deliv‐ery method ,labor duration ,Apgar score and postpartum hemorrhage volume of parturients were observed .[Results]The vaginal normal rate of DOULA instrument group was 54 .23% (64/118) ,which was higher than that of spinal group(42 .62% ,52/122) and control group(41 .12% ,51/124)( P < 0 .05) .The vaginal delivery rate of spinal group was 24 .59% (30/122) ,which was higher than that of DOULA instrument group and control group( P <0 .05) .The cesarean section rate of control group was 44 .35% (55/124) ,which was higher than that of spinal group and DOULA instrument group( P<0 .05) .The active stage duration of first labor stage and second labor stage dura‐tion of DOULA instrument group were (105 .35 ± 31 .55)min and (39 .11 ± 16 .34)min respectively ,which were shorter than those of spinal group[(163 .42 ± 33 .2)min and (50 .06 ± 19 .39)min] and control group[(331 .25 ± 35 .40)min and (87 .96 ± 31 .50)min]( P <0 .05) .The active stage duration of first labor stage and second labor stage duration of spinal group were shorter than those of control group( P <0 .05) .The mean VAS score of spinal group was (3 .01 ± 0 .87) ,which was lower than that of DOULA instrument group[(4 .24 ± 0 .91)] and control group[(6 .13 ± 1 .03)] ,and that of DOULA instrument group was lower than that of control group( P <0 .05) .[Conclusion]Labor analgesia with intraspinal anesthesia and DOULA instrument have satisfactory efficacy and can promote spontaneous delivery and reduce the rate of cesarean section without any adverse effect for mother and infant .