摘要
目的探讨自控腰硬联合分娩镇痛麻醉下，初产妇分娩过程中不同的停泵时机对产程、分娩结局和产妇满意度的影响。方法选择2013年4月-2013年12月间符合条件的初产妇120例，按先后顺序分到A、B、C三组，每完成10个另起一组，每组40例，腰硬联合麻醉分娩镇痛，A组宫口开全停泵，不再开泵；B组宫口开全停泵，胎儿娩出后立即开泵；C组一、二、三产程持续镇痛，三组均于第三产程结束，会阴缝合术毕结束镇痛并拔硬外镇痛管。观察比较产妇基本情况、镇痛效果（VAS）评分、第1、2、3产程时间、产后2h内出血量、缩宫素使用、剖宫产率、钳产率、羊水性质、产妇满意度，新生儿Apgar评分。结果三组间产后2h出血、新生儿Apgar评分、第三产程时间差异无统计学意义；A、B组产妇分娩痛比例较c组增加，会阴缝合痛或不适者较C组多，C组产妇满意度较A、B组增加，差异有统计学意义，A、B组间各项指标间差异无统计学意义。结论不同的停泵时机不增加第二产程，不影响新生儿Aparg评分，不增加产后出血，持续用药组增加缩宫素使用率，差异有统计学意义（P〈0．05），可能增加剖宫产趋势，但可提高产妇满意度。
Objective To explore the effects of different time of stopping pumping on stages of labour, delivery outcomes and parturients＇ satisfaction during delivery of primiparas who received self-controlled combined spinal- epidural anaesthesia for labour analgesia. Methods 120 eligible primiparas who were admitted from April 2013 to December 2013 were selected and assigned to group A, B and C according to admission order. Every ten people were assigned to each group once a time. Each group had 40 primiparas and received combined spinal-epidural labour analgesia. Pumping was stopped when cervix was wide open for group A and never restarted; pumping was stopped when cervix was wide open for group B, and restarted immediately after delivery; group C kept receiving labour analgesia all the way through the first, second and third stages. All three groups terminated analgesia at the third stage. The analgesia was terminated after perineorrhaphy and tubes for epidural analgesia were removed. Basic conditions of parturients, VAS scores, durations of the first, second and third stages, amount of bleeding in two hours after delivery, use of oxytocin, rate of caesarean section, rate of delivery by pliers, quality of amniotic fluid, satisfaction rate of parturients and Apgar scores were observed and compared. Results No differences of amount of bleeding in two hours after delivery, Apgar scores, and durations of the third stages were detected between the three groups; ratios of labour pain for parturients in group A and B were higher than those in group C, and the number of parturients who encountered pain during perineorrhaphy or felt uncomfortable was higher than that in group C. The satisfaction rate in group C was higher than that in group A and B, and the differences were statistically significant. No statistically significant differences of indices between group A and B were seen. Conclusion Different time of stopping pumping does not prolong the second stage, does not affect Apgar scores or exacerbate postpartum haemorrhage. Application rate of oxytocin increases in the group which receives continued analgesia （P 〈 0.05）, and the difference is statistically significant. Continued analgesia may promote the trend of caesarean section, yet improves parturients＇ satisfaction rate.
出处
《中国医药科学》
2014年第5期12-15,共4页
China Medicine And Pharmacy
基金
广东省佛山市经济和科技促进局科研立项(201308136)
关键词
腰硬联合分娩镇痛
0
1%罗哌卡因
产程
APGAR评分
产妇满意度
Combined spinal-epidural labour analgesia
0.1% of ropivacaine
Stages of labour
Apgar scores
Satisfaction rate of parturients
