自控硬膜外鎮痛結合導樂氏陪伴分娩的臨床效果

自控硬膜外鎮痛結合導樂氏陪伴分娩的臨床效果*

熱米拉·托乎提阿依尼沙汗·依明吾力也提·艾比布拉

(新疆維吾爾自治區婦幼保健醫院婦產科，新疆 烏魯木齊 830000)

【摘要】目的探討自控硬膜外鎮痛(PCEA)結合導樂氏陪伴分娩在自然分娩中的應用價值。方法以2012年6月至2013年7月擬行自然分娩足月妊娠的235例孕婦為研究對象，均為頭位單胎、無產科高危因素(妊娠期糖尿病、妊娠期高血壓疾病、妊娠期肝內膽汁淤積癥、妊娠合并心臟病等相關病理妊娠患者)、無麻醉及陰道分娩禁忌癥。其中135例行單純導樂氏陪伴分娩心理鎮痛為A組；100例采用低濃度羅哌卡因復合芬太尼產婦自控微電腦程控泵硬膜外神經阻滯結合導樂氏陪伴分娩鎮痛為B組；對比兩組分娩鎮痛效果、產程時間、剖宮產率、產后出血量、新生兒窒息發生率等相關指標。結果B組患者治療有效率達到98.00%，明顯高于B組陣痛有效率17.03%，差異有統計學意義(P<0.05)；兩組產程時間，包括活躍期、第二產程、第三產程及總產程時間相比差異無統計學意義(P>0.05)；兩組孕婦產后出血及新生兒窒息的發生率相比差異無統計學意義(P>0.05)，A組剖宮產率為31.85%，明顯高于B組25.00%，差異有統計學意義(P<0.05)。結論低濃度羅哌卡因復合芬太尼用于減輕孕產婦分娩疼痛的一種方法，鎮痛效果較傳統方法好,對胎兒無明顯毒副作用，安全可靠，值得臨床推廣應用。

【關鍵詞】硬膜外阻滯麻醉； 導樂陪伴； 分娩鎮痛

【中圖分類號】R 714.45【文獻標志碼】A

基金項目：國家自然科學基金(201317105)

收稿日期：( 2014-10-08； 編輯： 張文秀)

Clinical observation of Doula accompany delivery’s combination of epidural analgesiaRemila Tuohuti，Ayinishahan Yiming，Wuliyeti Aibibula

(DepartmentofObstetricsandGynecology,MaternalandChildHealthHospitalofXinjiangUygur

AutonomousRegion,Urumqi830000，China)

Abstract【】ObjectiveTo investigate the patient-controlled epidural analgesia (PCEA) combined with Doula accompany delivery's application value in natural childbirth. Methods235 pregnant women for vaginal delivery of a full-term pregnancy were included in the study. All the subjects were singleton with head position without obstetric risk factors including gestational diabetes, gestational hypertension, intrahepatic cholestasis of pregnancy complicated with heart disease and pregnancy associated pathological pregnancy and anesthetic contraindications and contraindication of vaginal delivery. 135 of them underwent doula accompany delivery analgesia's psychological were treated as group A and 100 cases with low concentration ropivacaine combined with fentanyl accompanied with computer control pump epidural nerve block combined with Doula's accompany delivery were treated as group B. The indexes related to production process, the rate of cesarean section, postpartum hemorrhage and neonatal asphyxia rate were observed. ResultsThe curative efficacy rate of patients in group B reached 98%, which was significantly higher than that of group B (17.03%) (P<0.05). The two group of labor time, including the active stage, the second stage of labor, the third stage of labor and total stage of labor time had no significant difference (P>0.05). The incidence of postpartum hemorrhage and newborn asphyxiatwo in two groups had no significant difference (P>0.05). The cesarean section rate of group A was 31.85%, which was significantly higher than that in group B (25%) (P<0.05). ConclusionLow concentration of ropivacaine with fentanyl for labor as a means of alleviating the pain during childbirth has higher analgesic effect than traditional methods and had no obvious toxic side effects on the fetus.

【Key words】Epidural anesthesia; Doula; Labor analgesia

分娩是一個比較復雜的生理過程，1998年開始開展了導樂氏陪伴分娩并獲得了較好的經濟和社會效益。但是導樂氏分娩是心理鎮痛，鎮痛效能有限，所以不能徹底的解決難以忍受的分娩疼痛問題.越來越多的孕婦要求可靠的、保障母兒安全的、舒適的鎮痛分娩方法。20……