CAJ | 학술논문

目的观察全产程分娩镇痛的效果及安全性.方法 90例单胎足月初产妇采用随机数字表法随机分为全产程镇痛组(A组)、活跃期镇痛组(B组)和对照组(C组),每组30例.A、B两组均采取硬-脊联合麻醉(combined spinal epidural anesthesia,CSEA),硬膜外置管接电子镇痛泵镇痛,A组产妇进入产程时予镇痛至产后2h,B组产妇宫颈口开至≥3 cm时予镇痛至宫口开全.C组产妇不予任何镇痛措施.记录镇痛前及产程不同时段疼痛视觉模拟评分法(visual analogue scales,VAS)评分、下肢运动阻滞情况、产程时间、分娩方式、孕妇副作用、产后24 h出血量、新生儿Apgar评分;采集产程开始、宫口开全及胎儿娩出时产妇静脉血标本,测定血浆肾素活性(plasma renin activity,PRA)、血管紧张素Ⅱ(angiotensinⅡ,AⅡ)、醛固酮(aldosterone,ALD)、皮质醇(cortisol,COR)的浓度.结果各组间产程时间、中转剖宫产率、下肢运动阻滞情况、产后24 h出血量及新生儿Apgar评分比较,差异无统计学意义(P＞0.05);A组VAS评分[第一产程潜伏期为(1.5±0.8)分,第一产程活跃期为(0.7±0.7)分,第二产程为(1.2±1.3)分,第三产程为(2.4±1.9)分]与C组比较,差异有统计学意义(P＜0.0l).A组产妇宫口开全是PRA为(3.5±1.9) μg/L,ALD为(239±74) μg/L,COR为(575±166) nmol/L,胎儿娩出时PRA为(3.5±1.5)μg/L,ALD为(200±68)μg/L,COR为(512±146) nmol/L,较B组、C组明显降低(P＜0.05).结论全产程硬-脊联合分娩镇痛能有效缓解产痛,减轻应激反应,对产程及分娩方式影响不大,是值得推广的安全有效的分娩镇痛方式.
목적 관찰전산정분면진통적효과급안전성.방법 90례단태족월초산부채용수궤수자표법수궤분위전산정진통조(A조)、활약기진통조(B조)화대조조(C조),매조30례.A、B량조균채취경-척연합마취(combined spinal epidural anesthesia,CSEA),경막외치관접전자진통빙진통,A조산부진입산정시여진통지산후2h,B조산부궁경구개지≥3 cm시여진통지궁구개전.C조산부불여임하진통조시.기록진통전급산정불동시단동통시각모의평분법(visual analogue scales,VAS)평분、하지운동조체정황、산정시간、분면방식、잉부부작용、산후24 h출혈량、신생인Apgar평분;채집산정개시、궁구개전급태인면출시산부정맥혈표본,측정혈장신소활성(plasma renin activity,PRA)、혈관긴장소Ⅱ(angiotensinⅡ,AⅡ)、철고동(aldosterone,ALD)、피질순(cortisol,COR)적농도.결과 각조간산정시간、중전부궁산솔、하지운동조체정황、산후24 h출혈량급신생인Apgar평분비교,차이무통계학의의(P＞0.05);A조VAS평분[제일산정잠복기위(1.5±0.8)분,제일산정활약기위(0.7±0.7)분,제이산정위(1.2±1.3)분,제삼산정위(2.4±1.9)분]여C조비교,차이유통계학의의(P＜0.0l).A조산부궁구개전시PRA위(3.5±1.9) μg/L,ALD위(239±74) μg/L,COR위(575±166) nmol/L,태인면출시PRA위(3.5±1.5)μg/L,ALD위(200±68)μg/L,COR위(512±146) nmol/L,교B조、C조명현강저(P＜0.05).결론 전산정경-척연합분면진통능유효완해산통,감경응격반응,대산정급분면방식영향불대,시치득추엄적안전유효적분면진통방식.
Objective To observe the effect and safety of total stage of labor analgesia.Methods Ninty full-term single birth primiparous women were randomized to three groups (n=30):the total stage analgesia group (group A),active-phase analgesia group (group B) and control group (group C).Patients in groups A and B were administrated combined spinal epidural anesthesia (CSEA),then epidural tube connected with electronic analgesia pump for labor analgesia.CSEA analgesia was performed while just getting into birth process,and maintained to 2 h after delivery in group A.CSEA analgesia was given at cervix dilation ≥ 3 cm and maintained to cervis dilation in group B.No analgesia was given in group C.The visual analogue scales (VAS) score,lower limbs motor block,labor time and method,adverse reaction of parturients during birth process,postpartum hemorrhage 24 h after labor,neonatal Apgar score were recorded.The venous blood samples of women were collected at the beginning of labor,active phase full dilatation and infant birth for mensuration of plasma renin activity (PRA),angiotensin Ⅱ (A Ⅱ),aldosterone (ALD) and cortisol (COR).Results There were no significant differences among the three groups total stage of labor analgesia,the conversion rate to caesarean section,lower limbs motor block,postpartum bleeding and newborn's Apgar score (P＞0.05).The VAS score for the first stage of the incubation period was (1.5±0.8),the first active phase was (0.7±0.7),the second stage of labor was (1.2±1.3),and the third stage of labor was (2.4±1.9) which in group A were significantly differences than that in group C(P＜0.01).During the stage of active phase full dilatationg,PRA was (3.5±1.9) μg/L,ALD was (239±74) μg/L,COR was (575±166) nmol/L and for infant brith PRA was (3.5±1.5) μg/L,ALD was (200±68) μg/L,COR was (512±146) nmol/L,which in group A obviously reduced compared with those in contemporaneous groups B and C (P＜0.05).Conclusions Labor analgesia with CSEA during total delivery course can effectively alleviate labor pain and relieve stress,and have little effect on labor time and method,suggesting it is worthy of wide promotion of safe and effective labor analgesia way.