摘要
目的：探讨全程自控硬膜外可行走分娩镇痛的安全性和可行性。方法：选择150例单胎头位足月妊娠的初产妇,随机分为三组（各组均为50例）,Ⅰ组宫口开张1cm左右,Ⅱ组宫口开张2~3cm,Ⅲ组为无镇痛分娩孕妇;Ⅰ组和Ⅱ组采用硬膜外麻醉,在腰L2-3椎间隙行硬膜外腔穿刺,成功后头向置管4cm,给予1%利多卡因3-5ml,连接硬膜外自控镇痛（PCEA）电子泵;麻醉药物选用0.1%甲磺酸罗哌卡因与2μg/ml芬太尼混和液100ml;首次剂量6-8ml,自控量PCA6ml/次,锁定时间为15min,最大剂量24ml/h,Ⅰ组一直持续至孕妇完成整个产程,Ⅱ组至宫口开全关闭电子泵,两组产妇在第一产程中由家属搀扶走动10min左右;Ⅲ组为自然分娩者,不用任何镇痛剂;观察镇痛效果、运动阻滞状况、记录第一、二、三产程时间,产后出血量、分娩方式及催产素的使用情况、新生儿娩出后1、5min的Apgar＇s评分,观察孕妇的满意度及分娩镇痛的不良反应。结果：Ⅰ组、Ⅱ组中镇痛成功率达96%,两组间镇痛效果差异无统计学意义（P〉0.05）;Ⅲ组中61%孕妇有中度疼痛,20%有极度疼痛;Ⅰ组、Ⅱ组与Ⅲ组间镇痛效果差异有统计学意义（P〈0.01）;Ⅰ组94%产妇用药后无运动神经阻滞,3例下肢有轻微麻木感,2例能屈曲膝关节,1例能屈曲踝关节;Ⅱ组与Ⅰ组情况相似,两组差异无显著性;Ⅲ组与Ⅰ组、Ⅱ组差异有显著性（P〈0.05）。催产素的使用率Ⅰ组为100%,Ⅱ组60%,Ⅲ组18%。Ⅰ组与Ⅲ组相比第一产程时间差异无显著性;Ⅱ组与Ⅰ组、Ⅲ组相比第一产程时间差异有显著性（P〈0.05）;Ⅰ组的阴道助产率高于Ⅱ组,Ⅰ组与Ⅱ组的顺产率及阴道助产率高于Ⅲ组,但剖宫产率低于Ⅲ组;新生儿娩出后1,5min的Apgar＇s评分各组间差异无显著性;各组产后出血量差异无显著性;孕妇的满意度在Ⅰ组（99%）和Ⅱ组（92%）均大于Ⅲ组（2%）（P〈0.01）;Ⅰ组有3例皮肤瘙痒,Ⅱ组有2例;Ⅰ组出现尿潴留4例,Ⅱ组有2例,Ⅲ组有1例。结论：低浓度国产甲磺酸罗哌卡因合并芬太尼用于全程自控硬膜外可行走分娩镇痛,接近理想分娩镇痛技术。
Objective：To investigate the safety and feasibility of walking PCEA used in labor . Methods ： 150 normal full-time parturients having single birth were randomly divided into three groups（ n = 50 in each group）. In the frist group（ Ⅰ ） , ostium uteri was opened about 1cm ,in the second group（Ⅱ） , ostium uteri was opened two 2 -3cm,but in the third group（ Ⅲ ） , no analgesia was given. Group Ⅰ and groupⅡ were given epidural anesthesia ,which is given by nyxis between L2 - L3 intervertebral space. Put the tube headward about 4cm after that, then join to domestic ＂anpeng＂ electronic pump of PCEA to give 1% lidocaine about 3 - 5ml. The junks were the domestic 0.1% MSA ropivacaine and 100ml of 2ug/ml fentanyl mixing liquor. The initial dose was 6 -8ml; the rate of PCA was 6ml once; tbe caging time was 15 min;the max dose was 24ml/h; group Ⅰwas kept until pregnant women finished their labor. group Ⅱ was kept until the electric pump was closed and ostium uteri was opened, pregnant women in group Ⅰ and group Ⅱ were helped to walk about 10 min by their relatives in the first stage of labor. Group m was spontaneous labor without any paregoric in order to observe the analgesia effect, the conditions of movement blockage, the labor times of Group ⅠGroup Ⅱ ／ Group Ⅲ respectively, the blood volume of postpartum hemorrhage, the labor mode, the usage of alpha hypophamine, the 1,5 Apgar＇s evalution of newborn infant alter labor, the satisfaction of pregnant woman and the adverse effect of labor analgesia. Results： The achievement ratio of analgesia in Group Ⅰ and Group Ⅱ was 96%. Analgesia effect between the two groups was not statistically significant（ P 〉 0.05 ）. 61% pregnant women in Group Ⅲ had midrange pains, 20% had pains to the utmost. The analgesia effect between Group Ⅰ ／GroupⅡ and Group Ⅲwas not statistically significant. 94% pregnant women in group Ⅰ had not nerve block effects;3 examples had slight insensible feeling;2 examples＇ knee joint could flex and 1 example＇ s ankle-joint could flex. There were not statistical significance between Group Ⅰ and Group Ⅱ , There were statistical significance between Group Ⅰ ／Group Ⅱ and Group Ⅲ （P 〈 0.05 ）. The uses of alpha hypophamine were 100% in GroupⅠ , 60% in Group Ⅱ , 18% in Group Ⅲ respectively;There were not statistical significance between group Ⅰand Ⅱ in the first stage of labor and statistically significant between group Ⅱ and groupⅠ ／group Ⅲ （P 〈 0.05 ） ;The vagina muliebris yield in group Ⅰ was higher than that in groupⅡ; the spontaneous labor rate and vagina maliebris yield in group Ⅰ ／group Ⅱ were higher than that in group Ⅲ, but the uterine-incision delivery rate in group Ⅰ／group Ⅱ was lower than that in group Ⅲ. The values of 1,5 Apgar＇s evalution of newborn infant were not statistically significant and the blood volume of postpartum hemorrhage was also not statistically significant among 3 groups. The satisfaction degrees of pregnant women in group Ⅰ （ 99% ） and group Ⅱ （ 92% ） was both higher than that in group Ⅲ （ 2% ） （ P 〈 0.01 ） ; 3 rases in group Ⅰ and 2 eases in group Ⅱ had Itch of skin ; urinary retention happened to 4 cases in groupⅠ ,2 cases in group Ⅱ and 1 cases in group In. Conclusions： MSA ropivacaine of low concentration combined with fentanyl could be applied to walking PECA used in labor,which was approximate to the labor analgesia technology, and was to be worthy of clinical application .
出处
《赣南医学院学报》
2009年第1期20-22,共3页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
基金
2006年赣州市科委计划课题
关键词
全程
硬膜外
分娩镇痛
罗哌卡因
芬太尼
whole range
Epidural
labor analgesia
domestic ropivacaine
electronic pump
