CAJ | 학술논문

目的：比较不同时机双管法硬膜外分娩镇痛对母婴的影响。方法自愿接受分娩镇痛的足月、单胎、头位初产妇120例，均采用L1－2，L4－5间隙硬膜外穿刺置管行双管法硬膜外分娩镇痛，根据开始分娩镇痛的时机分为2组（n＝60），A组：开始于活跃期（宫口扩张＞3.0 cm），结束于宫口开全。 B组：开始于潜伏期（宫口扩张＜3.0 cm）结束于胎儿娩出。同时随机选取不接受分娩镇痛的足月、单胎、头位初产妇60例为对照组（ C组）。于镇痛前即刻（ C组于宫口扩张3 cm时）、镇痛开始后10 min、30 min、宫口扩张7～8 cm及10 cm，第二产程中及胎儿娩出后行VAS评分，采用改良Bromage评分法测定下肢肌力。记录镇痛时间、产程时间、分娩方式、催产素使用情况、药物用量、胎儿娩出后1 min、5 min时Apgar评分、产妇满意度评分及不良反应发生情况。结果与C组比较，A组和B组镇痛开始后各时点VAS评分降低，第一产程时间缩短，催产素使用率升高，剖宫产率降低（P＜0.05）；B组和A组比较，第二产程VAS评分降低，产妇满意度评分提高，其余指标差异无统计学意义（ P＞0.05）。结论双管法硬膜外分娩镇痛始于潜伏期，结束于胎儿娩出的全程分娩镇痛可提供更完善的镇痛，提高产妇满意度，且不延长产程，对新生儿同样安全。
목적：비교불동시궤쌍관법경막외분면진통대모영적영향。방법자원접수분면진통적족월、단태、두위초산부120례，균채용L1－2，L4－5간극경막외천자치관행쌍관법경막외분면진통，근거개시분면진통적시궤분위2조（n＝60），A조：개시우활약기（궁구확장＞3.0 cm），결속우궁구개전。 B조：개시우잠복기（궁구확장＜3.0 cm）결속우태인면출。동시수궤선취불접수분면진통적족월、단태、두위초산부60례위대조조（ C조）。우진통전즉각（ C조우궁구확장3 cm시）、진통개시후10 min、30 min、궁구확장7～8 cm급10 cm，제이산정중급태인면출후행VAS평분，채용개량Bromage평분법측정하지기력。기록진통시간、산정시간、분면방식、최산소사용정황、약물용량、태인면출후1 min、5 min시Apgar평분、산부만의도평분급불량반응발생정황。결과여C조비교，A조화B조진통개시후각시점VAS평분강저，제일산정시간축단，최산소사용솔승고，부궁산솔강저（P＜0.05）；B조화A조비교，제이산정VAS평분강저，산부만의도평분제고，기여지표차이무통계학의의（ P＞0.05）。결론쌍관법경막외분면진통시우잠복기，결속우태인면출적전정분면진통가제공경완선적진통，제고산부만의도，차불연장산정，대신생인동양안전。
Objective To compare the effects of labor double -catheter epidural analgesia at different laboring phases of parturients and neonates.Methods 120 nutliparous women of full term pramipara were randomly divided into 3 groups(n=60 each):control group(group C);PCEA initiated in latent phase (cervical dilatation <3.0 cm)and ended in delivery of fetus group (group B)and PCEA initiated in active phase (cervical dilatation>3.0 cm)and ended in cervical dilatation of 10 cm(group A).Group A and Group B interfered with double -cathe-ter epidural block at the level of L1-2 and L3-4.The intensity of pain was measured with VAS(0=no pain,10:worst pain)before analgesia,at 10and 30 min after the beginning of PCEA and cervical dilatation of 7~8 cm and 10 cm , and VAS score was done .The length of every stage , duration of analgesia ,delivery mode ,the amount of oxytocin usage ,amount of medicine , Apgar score after 1 and 5 rain after the delivery of ba-by, maternal satisfaction and adverse effect were recorded .Results In PCEA initiated in latent phase or active phase VAS score reduced sig-nificantly,the duration of 1st stage of labor reduced ,and the rate of cesarean section increased , and the use of oxytoein reduced in A and B groups as compared with group C ,but there was no significant difference in the variables above between A group and B group .Group B sig-nificantly reduced VAS score and increased maternal satisfaction on the duration of the 2nd stage of labor as compared with group A .Con-clusion Labor double-catheter epidural analgesia initiating in latent phase and ending in delivery of fetus group can provide more comfort -able analgesia and increase maternal satisfaction but do not prolong the duration of labor and be safe for the newborn .