摘要
目的比较产妇自控硬膜外镇痛(patient controlled epidural analgesia,PCEA)、笑气(nitrousoxide,N2O)吸入镇痛和药物镇痛三种分娩镇痛方法的镇痛效果及其对产妇及新生儿的影响。方法选择2004年3月至2004年10月在山西医科大学第一医院住院分娩,无麻醉禁忌证,自愿接受分娩镇痛的产妇90例,其中PCEA(PCEA组)、笑气吸入镇痛(笑气组)、药物镇痛(药物组)各30例。选择同期住院、条件相同、未采取任何镇痛措施分娩的孕妇30例为对照组(分组征得患者本人的知情同意)。PCEA组于产程活跃期给予硬膜外麻醉,接自控镇痛泵联合注入罗哌卡因和芬太尼;笑气组于产程活跃期给予吸入含50%N2O和50%O2的混合气体;药物组于潜伏期给予哌替啶(度冷丁)100mg肌内注射,于活跃期给予地西泮(安定)10mg静脉推注;对照组未给予任何镇痛措施。分别观察以上4组产妇的镇痛效果、产程时间、分娩方式、产后出血量、产妇血氧饱和度、新生儿脐动脉血的血气分析,以及新生儿窒息情况。结果14组产妇年龄、身高、体重和孕周等比较,差异无显著意义(P>0.05);24组镇痛效果比较,差异有显著意义(χ2=119.888,P=0.000);34组产程时间比较:即潜伏期、活跃期、第二产程、总产程比较,差异无显著意义(P>0.100);44组产后出血量比较,差异无显著意义(P>0.100);54组产妇分娩方式及新生儿窒息率的比较:差异无显著意义(χ2=2.410,P=0.878;P>0.100);64组产妇血氧饱和度及新生儿脐血血气分析结果比较,差异无显著意义(P>0.100)。结论产妇PCEA用于分娩镇痛有确切的镇痛效果,对产妇及新生儿无明显不良反应,可作为分娩镇痛的首选方法。笑气吸入和药物镇痛效果虽次于产妇PCEA组,但方便简单,对母儿亦无明显不良反应,可在基层单位推广使用。
Objective To investigate and compare the effectiveness and influence among the methods of patient controlled epidural analgesia （PCEA）, inhalation of nitrous oxide （N2O） and drug analgesia. Methods To select Mar. 2004 to Oct. 2004 pregnant women 120 cases：the PCEA group, the nitrous oxide group, the drug analgesia group and the control group. The pregnant women of the PCEA group were injected fentanyl and ropivacaine in the epidural space. The nitrous oxide group were inhaled nitrous oxide （50%） premixed with oxygen （50%）. The pregnant women of drug analgesia group were injected diazepam during latent phase and pethidine during active phase. The analgesia was not used in the control group. The degree of pain, duration of the labor, way of delivery, bleeding volume, rate of anoxia of newborn, blood gas analysis to maternal radius artery and fetal umbilical blood of 4 groups were observed. Results The effect for analgesia labor of the PCEA group was much better than that of the nitrous oxide group and the drug analgesia group （χ^2= 119. 888, P = 0. 000）. There were no significant differences among 4 groups in the latent phase, the active phase, the second stage of labor, and the total stage of labor （P〉0. 100）. The bleeding volume of 4 groups were alike to each other （P〉0. 100）. The way of delivery has no significant difference among 4 groups （χ^2= 2. 410, P= 0. 878）. The blood analysis to maternal radius artery, fetal umbilical blood and the rate of anoxia of newborns of 4 groups revealed no significant differences （P〉0. 100）. Conclusion The effectiveness of the PCEA for labor analgesia is confirmed and has rarely side-effect, and it can be the first choice. The inhalation of nitrous oxide and the drug analgesia also can safely provide effective labor analgesia.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2007年第6期316-319,共4页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
关键词
分娩镇痛
产科
硬膜外麻醉
氧化亚氮
labor analgesia
obstetrical
anesthesia epidural
nitrous oxide（N2O）
