硬膜外麻醉在分娩鎮(zhèn)痛中的臨床研究

[摘要] 目的 探討硬膜外麻醉在分娩鎮(zhèn)痛中的有效性和安全性。 方法 采用硬膜外麻醉進(jìn)行分娩鎮(zhèn)痛的產(chǎn)婦 360 例（研究組），未采取任何鎮(zhèn)痛措施的360例產(chǎn)婦（對照組），比較兩組分娩疼痛程度、產(chǎn)程時(shí)間、新生兒出生評分、產(chǎn)后出血量及陰道助產(chǎn)率。結(jié)果 研究組鎮(zhèn)痛效果明顯優(yōu)于對照組，兩組產(chǎn)程長短、新生兒窒息率、陰道助產(chǎn)率及產(chǎn)后出血量均無顯著性差異。 結(jié)論 硬膜外分娩鎮(zhèn)痛能有效減輕分娩疼痛，對產(chǎn)程無明顯影響，不增加新生兒窒息、產(chǎn)后出血及陰道助產(chǎn)率，增強(qiáng)了產(chǎn)婦分娩信心，對降低剖宮產(chǎn)率起到有益作用，值得臨床推廣。

[關(guān)鍵詞] 分娩鎮(zhèn)痛；產(chǎn)程；新生兒窒息；產(chǎn)后出血

[中圖分類號] R714.1 [文獻(xiàn)標(biāo)識碼] B [文章編號] 2095-0616（2012）21-97-02

The clinical observation of epidural anesthesia for labor analgesia

ZHENG Bi TANG Yonghong ZENG Li

Department of Obstetrics， the Second People's Hospital of Yibin City，Yibin 644000，China

[Abstract] Objective To discuss the effect and safety of epidural analgesia for labor analgesia. Methods 360 women who took epidural anesthesia for labor analgesia were selected as experiment group， while another 360 women were selected as control group which have not been given any labor analgesia.Compared with the labor pain，the stage of labor， Apgar score and postpartum hemorrhage between two groups. Results The analgesic effect was better than control group， the labor pain， the stage of labor， Apgar score， vaginal birth rate and postpartum hemorrhage between two groups were no significant difference. Conclusion Epidural labor analgesia can effectively reduce the labor pain. It has no influence on the total stage of labor， and cannot increase vaginal birth rate， neonatal asphyxia and postpartum hemorrhage. It can enhance the maternity confidence， which is benefit to reduce the rate of cesarean section and worth widely using in clinic.

[Key words] Labor analgesia； Stage of labor； Neonatal asphyxia； Postpartum hemorrhage

對大多數(shù)婦女來說，生產(chǎn)的疼痛是她們一生中經(jīng)歷的最劇烈的疼痛[1]。產(chǎn)痛可致產(chǎn)婦情緒緊張、焦慮、進(jìn)食減少，宮縮乏力致產(chǎn)程延長；也可致產(chǎn)婦過度通氣、耗氧量增加，引起胎兒低氧血癥和酸中毒；還可致產(chǎn)婦兒茶酚胺釋放增加、抑制子宮收縮、產(chǎn)程延長、子宮動(dòng)脈收縮性胎兒窘迫等[2]，因此分娩鎮(zhèn)痛是現(xiàn)代文明產(chǎn)科的標(biāo)志，也是提高圍產(chǎn)醫(yī)學(xué)質(zhì)量的重要舉措。為探討硬膜外分娩鎮(zhèn)痛的安全性和有效性，本研究觀察筆者所在醫(yī)院2009～2011年實(shí)施分娩鎮(zhèn)痛的產(chǎn)婦資料，與同期未施行分娩鎮(zhèn)痛的陰道分娩的婦女進(jìn)行對比分析如下。

1 資料與方法

1.1 一般資料

選擇2009年1月～2011年12月在宜賓市第二人民醫(yī)院住院經(jīng)陰道分娩的自愿實(shí)施硬膜外分娩鎮(zhèn)痛的產(chǎn)婦360例，作為研究組，同期住院未實(shí)施分娩鎮(zhèn)痛的360例設(shè)為對照組。……