不同椎管内镇痛方式在分娩镇痛中的效果比较(1)
摘 要 目的：探讨低浓度罗哌卡因复合舒芬太尼连续硬膜外阻滞或腰硬联合阻滞镇痛分娩的效果。方法：选取244例行椎管内分娩镇痛的产妇，根据椎管内阻滞方法的不同分为硬膜外阻滞组(n=131)和腰硬联合阻滞组(n=113)。比较两组产程情况、产后出血量、新生儿Apgar评分和镇痛效果。结果：与硬膜外阻滞组相比，腰硬联合阻滞组各产程时间和总产程时间、麻醉起效时间、完善时间均较短(P<0.05)；给药后5、10、15 min产妇VAS评分较低(P<0.05)。两组的分娩方式，产后出血量，新生儿1 min、5 min Apgar评分，麻醉药物药量，给药后30、60 min产妇VAS评分差异均无统计学意义(P>0.05)。结论：腰硬联合阻滞分娩镇痛在不增加剖宫产率及产后出血量、不影响母婴健康的基础上，产程更快，镇痛效果更好。
关键词 连续硬膜外阻滞 腰硬联合阻滞 镇痛分娩
中图分类号：R614.42； R714.3 文献标志码：A 文章编号：1006-1533(2020)19-0028-03
Comparison of the effects of different intraspinal analgesia methods in labor analgesia
GOU Zihan1*， CHEN Shaoqiang1， LIAO Yu2
(1. Department of Surgical Anesthesia； 2. Venous Configuration Center， the People’s Hospital of Kaizhou District， Chongqing 405400， China)
ABSTRACT Objective： To investigate the effect of low concentrations of ropivacaine combined with sufentanil continuous epidural block or lumbar-epidural block for analgesic delivery. Methods： Two hundred and forty-four parturients undergoing intravertebral analgesia were divided into an epidural block group (n=131) and a lumbar-epidural block group(n=113). The labor stage， postpartum hemorrhage， neonatal Apgar score and analgesic effect were compared between the two groups. Results： The duration of labor， the total duration of labor， the onset of anesthetic effect and the improvement time were shorter and the maternal VAS scores at 5，10 and 15 min after administration were lower in the lumbar-epidural block group than the epidural block group (P<0.05). There were no significant differences between the two groups in delivery mode， postpartum bleeding volume， neonatal 1 min， 5 min Apgar score， anesthetic drug volume， and maternal VAS score at 30， 60 min after administration (P>0.05). Conclusion： The lumbar-hard combined block does not increase the cesarean section rate and postpartum hemorrhage and affect the health of the mother and baby， and its labor process is faster and the analgesic effect is better.
KEY WORDS continuous epidural block； lumbar joint block； analgesic delivery
分娩疼痛的程度遠超多种疾病，分娩镇痛可有效缓解分娩疼痛，减少产妇分娩时负面心理，具有重要的社会和临床价值。分娩镇痛方法有很多种。椎管内镇痛具有安全范围高、镇痛效果确切等优点，是目前临床上应用最广、最有效的分娩镇痛方式[1]。连续硬膜外阻滞和腰硬联合阻滞是目前较多选择的椎管内阻滞分娩镇痛方法[2]。本文通过探讨低浓度罗哌卡因复合舒芬太尼连续硬膜外阻滞或腰硬联合阻滞镇痛分娩的效果及其对产程、分娩结局及新生儿的影响，以期为临床应用提供一定参考。
1 资料与方法
1.1 一般资料
选取2018年7月—2019年7月在我院分娩的产妇244例行椎管内分娩镇痛，本研究经我院伦理委员会审批通过，所有产妇及家属已获得知情同意，均为足月、单胎、头位，年龄21～35岁，初产妇，无严重妊娠合并症及并发症。产前检查符合阴道试产条件，ASIⅠ～Ⅱ级，无心、肺疾病及肝肾功能不全，无分娩镇痛禁忌证。根据椎管内阻滞方法的不同分为硬膜外阻滞组(n=131)和腰硬联合阻滞组(n=113)。硬膜外阻滞组平均年龄(28.4±5.7)岁，平均孕周(39.5±0.8)周；腰硬联合阻滞组平均年龄(29.1±6.3)岁，平均孕周(39.5±0.9)周。两组产妇年龄、孕周差异无统计学意义(P>0.05)。, http://www.100md.com(苟子瀚 陈少强 廖宇)
关键词 连续硬膜外阻滞 腰硬联合阻滞 镇痛分娩
中图分类号：R614.42； R714.3 文献标志码：A 文章编号：1006-1533(2020)19-0028-03
Comparison of the effects of different intraspinal analgesia methods in labor analgesia
GOU Zihan1*， CHEN Shaoqiang1， LIAO Yu2
(1. Department of Surgical Anesthesia； 2. Venous Configuration Center， the People’s Hospital of Kaizhou District， Chongqing 405400， China)
ABSTRACT Objective： To investigate the effect of low concentrations of ropivacaine combined with sufentanil continuous epidural block or lumbar-epidural block for analgesic delivery. Methods： Two hundred and forty-four parturients undergoing intravertebral analgesia were divided into an epidural block group (n=131) and a lumbar-epidural block group(n=113). The labor stage， postpartum hemorrhage， neonatal Apgar score and analgesic effect were compared between the two groups. Results： The duration of labor， the total duration of labor， the onset of anesthetic effect and the improvement time were shorter and the maternal VAS scores at 5，10 and 15 min after administration were lower in the lumbar-epidural block group than the epidural block group (P<0.05). There were no significant differences between the two groups in delivery mode， postpartum bleeding volume， neonatal 1 min， 5 min Apgar score， anesthetic drug volume， and maternal VAS score at 30， 60 min after administration (P>0.05). Conclusion： The lumbar-hard combined block does not increase the cesarean section rate and postpartum hemorrhage and affect the health of the mother and baby， and its labor process is faster and the analgesic effect is better.
KEY WORDS continuous epidural block； lumbar joint block； analgesic delivery
分娩疼痛的程度遠超多种疾病，分娩镇痛可有效缓解分娩疼痛，减少产妇分娩时负面心理，具有重要的社会和临床价值。分娩镇痛方法有很多种。椎管内镇痛具有安全范围高、镇痛效果确切等优点，是目前临床上应用最广、最有效的分娩镇痛方式[1]。连续硬膜外阻滞和腰硬联合阻滞是目前较多选择的椎管内阻滞分娩镇痛方法[2]。本文通过探讨低浓度罗哌卡因复合舒芬太尼连续硬膜外阻滞或腰硬联合阻滞镇痛分娩的效果及其对产程、分娩结局及新生儿的影响，以期为临床应用提供一定参考。
1 资料与方法
1.1 一般资料
选取2018年7月—2019年7月在我院分娩的产妇244例行椎管内分娩镇痛，本研究经我院伦理委员会审批通过，所有产妇及家属已获得知情同意，均为足月、单胎、头位，年龄21～35岁，初产妇，无严重妊娠合并症及并发症。产前检查符合阴道试产条件，ASIⅠ～Ⅱ级，无心、肺疾病及肝肾功能不全，无分娩镇痛禁忌证。根据椎管内阻滞方法的不同分为硬膜外阻滞组(n=131)和腰硬联合阻滞组(n=113)。硬膜外阻滞组平均年龄(28.4±5.7)岁，平均孕周(39.5±0.8)周；腰硬联合阻滞组平均年龄(29.1±6.3)岁，平均孕周(39.5±0.9)周。两组产妇年龄、孕周差异无统计学意义(P>0.05)。, http://www.100md.com(苟子瀚 陈少强 廖宇)