摘要
目的 :研究蛛网膜下隙 硬膜外间隙联合阻滞 (CombinedSpinalEpiduralAnalgesia ,CSEA)应用于分娩镇痛的临床效果。方法 :90例初产妇按入院前后及个人同意分成三组。C组 :对照组 ,未用任何镇痛方法。CEA组 :0 .12 5 %罗哌卡因 + 2 μg /ml芬太尼组。CSEA组 :L2 /3CSEA联合穿刺成功后 ,蛛网膜下腔注入 0 .17%布比卡因 1ml + 2 .5 μg芬太尼 1ml,常规向头端置入硬膜外导管。观察产妇的分娩、镇痛情况及镇痛前后对产妇应激及泌乳的影响。结果 :1.CEA组和CSEA组产妇镇痛效果满意 ,和对照组比较有显著性差异 (P <0 .0 5 ) ,但CSEA组起效时间明显短于CEA组 ,且同一时点镇痛效果优于CEA组 (P <0 .0 5 ) ;2 .CSEA组产程活跃期为 14 2分钟和CEA组 15 3分钟短于均对照组 191分钟 ,有统计学差异 ;3.镇痛组与对照组比较无运动神经的阻滞 ;4 .三组产妇血浆皮质醇的浓度呈逐步上升趋势 ,CEA、CSEA组镇痛后比镇痛前的皮质醇含量变化不明显 (P >0 .0 5 ) ,对照组镇痛后比镇痛前的皮质醇含量明显升高 ,有统计学差异 (P <0 .0 5 ) ;5 .三组间各时点催乳素含量及产后泌乳始动时间差别不显著 (P >0 .0 5 )。结论 :CSEA和CEA都是行之有效的分娩镇痛方法 ,但CSEA起效迅速、镇痛完善、缩短活跃期产程。
Objective:To study the effects of combined spinal epidural analgesia (CSEA) on relieving labor pain. Methods:90 primipara were divided into three groups. The control group (C) received no analgesia. The continual epidural analgesia group (CEA) got 0.125% ropivacaine+fentanyl 2μg/ml. The CSEA group received spinal administration with 0.17% bupivacaine 1 ml and 2.5μg fentanyl 1 ml, catheterized through epidural L_(2/3) toward head. The pain intensity,motor function for ambulation,vital signs, fetal heart rate (FHR), birth process, delivery mode and the consumed volumes of oxytocin were recorded. Results:1. Both CEA and CSEA showed good effects on relief of labor pain. The effect of CSEA was better and earlier than CEA ( P <0.05). 2. Active phase of labor stage in CSEA group and CEA group was 142 and 153 minutes, respectively, and was significantly shorter than control group (191 minutes, P <0.05). 3. There were no motor nerve block in any group. 4. The serum cortisol concentrations of labor women were only significantly increased after analgesia than that of before analgesia in control group ( P <0.05). 5. There was no significant difference of serum PRL concentration or the initial time of lactation among three groups ( P >0.05). Conclusion: CSEA and CEA were safe and effective for labor pain relief. But CSEA had superiority than CEA because of its consummate analgesic effect, rapid onset, shortening active phase of labor stage.
出处
《中国疼痛医学杂志》
CAS
CSCD
2004年第2期94-97,共4页
Chinese Journal of Pain Medicine
关键词
蛛网膜下隙
硬膜外间隙
联合阻滞
CSEA
分娩镇痛
临床观察
Combined spinal-epidural analgesia
Labor analgesia
Ropivacaine
Bupivacaine
Serum cortisol
Serum prolactin
