腰硬联合麻醉和硬膜外麻醉在分娩镇痛中的效果对比及对妊娠结局的影响
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摘要
目的:探究在分娩镇痛中实施腰硬联合麻醉和硬膜外麻醉在临床应用中的效果对比以及对妊娠结局的影响。方法:选取2016年8月-2017年5月本院120例产妇作为本次研究对象,按照随机数字表法将其分为A、B、C组,各40例。A组予以硬膜外麻醉,B组予以腰硬联合麻醉,C组未接受麻醉镇痛分娩,并对三组的VAS评分、产程进展情况、新生儿Apgar评分进行比较。结果:三组5、10、30、60 min、4~6 h的VAS评分比较,差异均有统计学意义(P<0.05)。三组第二产程比较,差异无统计学意义(P>0.05);活跃期时间、第三产程比较,差异均有统计学意义(P<0.05)。三组1、5、10 min的新生儿Apgar评分比较,差异均有统计学意义(P<0.05)。结论:在临床上分娩镇痛中实施腰硬联合麻醉,其起效时间更短、镇痛效果更为明显、用药量更少、可加速产程的进展尤其是活跃期的进展,并且不影响母婴安全,值得临床推广使用。但麻醉后期(腰麻给药后4~6 h)产妇分娩疼痛有稍增加的感觉,故对于实施单次腰麻的腰硬联合麻醉更适合用于产程进展较快的经产妇,而对于产程较长的初产妇,在麻醉后期应该考虑增加硬膜外持续加药的速度。
Objective:To explore the effects of combined spinal-epidural anesthesia and epidural anesthesia on labor analgesia and its effect on pregnancy outcome.Method:A total of 120 cases of parturients from August 2016 to May 2017 in our hospital were selected as study objects.According to the random number table method,they were divided into group A,group B and group C,40 cases in each group.The group A was given epidural anesthesia,the group B was given combined spinal-epidural anesthesia and epidural anesthesia and the group C was not received anaesthesia and analgesia.The VAS scores,the progress of the labor process and the Apgar scores of the newborn were compared among the three groups.Result:There were significant differences in VAS scores of 5,10,30,60 min and 4-6 h among the three groups(P<0.05).There was no significant difference in the second stage of labor process among the three groups(P>0.05);there were significant differences in the active phase and the third labor process(P<0.05).There were significant differences in neonatal Apgar scores of 1,5,10 min among the three groups(P<0.05).Conclusion:The onset time of combined spinalepidural anesthesia in clinical labor analgesia is shorter,the analgesic effect is more obvious,and the dosage of drugs is less.It can accelerate the progress of labor process,especially the progress of active phase and does not affect the safety of mother and infant.It is worthy of clinical promotion and application.But during the later stage of anesthesia(4-6 hours after the administration of spinal anesthesia),the labor pain increase slightly,so the combined spinal-epidural anesthesia with single spinal anesthesia is more suitable for parturient with faster progress of labor.While for primipara with longer period of labor,it should be considered to increase the speed of continuous epidural medication at the later stage of anesthesia.
Objective:To explore the effects of combined spinal-epidural anesthesia and epidural anesthesia on labor analgesia and its effect on pregnancy outcome.Method:A total of 120 cases of parturients from August 2016 to May 2017 in our hospital were selected as study objects.According to the random number table method,they were divided into group A,group B and group C,40 cases in each group.The group A was given epidural anesthesia,the group B was given combined spinal-epidural anesthesia and epidural anesthesia and the group C was not received anaesthesia and analgesia.The VAS scores,the progress of the labor process and the Apgar scores of the newborn were compared among the three groups.Result:There were significant differences in VAS scores of 5,10,30,60 min and 4-6 h among the three groups(P<0.05).There was no significant difference in the second stage of labor process among the three groups(P>0.05);there were significant differences in the active phase and the third labor process(P<0.05).There were significant differences in neonatal Apgar scores of 1,5,10 min among the three groups(P<0.05).Conclusion:The onset time of combined spinalepidural anesthesia in clinical labor analgesia is shorter,the analgesic effect is more obvious,and the dosage of drugs is less.It can accelerate the progress of labor process,especially the progress of active phase and does not affect the safety of mother and infant.It is worthy of clinical promotion and application.But during the later stage of anesthesia(4-6 hours after the administration of spinal anesthesia),the labor pain increase slightly,so the combined spinal-epidural anesthesia with single spinal anesthesia is more suitable for parturient with faster progress of labor.While for primipara with longer period of labor,it should be considered to increase the speed of continuous epidural medication at the later stage of anesthesia.
引文
[1]郭靖,梁艳,常姣娥.腰硬联合与硬膜外麻醉用于镇痛分娩临床效果分析[J].中国妇幼健康研究,2016,27(12):1517-1519,1551.
[2]谭选军,申黎光,张川,等.腰硬联合麻醉与持续硬膜外麻醉用于剖宫产术的效果对比分析[J].陕西医学杂志,2015,44(2):180-182.
[3]杨敏.剖宫产采用腰硬联合与硬膜外麻醉术后镇痛效果临床对比研究[J].中国医药导刊,2016,18(6):599-601.
[4]董丽萍,蔡莉,刘虹,等.腰硬联合麻醉应用于无痛分娩的疗效及安全性分析[J].中国现代医学杂志,2015,25(3):91-93.
[5]何永冠,曹晓霞.硬膜外麻醉与腰硬联合麻醉在剖宫产术中的应用效果比较[J].中国急救医学,2016,36(z1):225-226.
[6]许斌.腰硬联合麻醉分娩镇痛48例效果观察及护理[J].齐鲁护理杂志,2015,21(6):33-34.
[7]Sviggum H P,Yacoubian S,Liu X,et al.The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia:a randomized controlled study[J].International Journal of Obstetric Anesthesia,2015,24(1):15-21.
[8]郝凤梅,苗华艳.氯普鲁卡因注射液联合吗啡注射液硬膜外麻醉对剖宫产术后镇痛的临床研究[J].中国临床药理学杂志,2017,33(2):112-115.
[9]李建宾,惠建伟,何婉雯,等.腰硬联合麻醉对剖宫产产妇围术期凝血功能、RAAS活性及术后镇痛效果的影响[J].国际检验医学杂志,2017,38(7):930-932,935.
[10]韩明,韩志强,王蕾,等.罗哌卡因用于腰硬联合麻醉及其扩散的研究进展[J].中国药物与临床,2016,16(4):527-529.
[11]Heesen M,Boehmer J,Kloehr S,et al.The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor,maternal,and neonatal outcomes:a systematic review and meta-analysis[J].Anesthesia and Analgesia:Journal of the International Anesthesia Research Society,2015,121(1):149-158.
[12]应震阳,黄晓东.第一产程活跃期减速期分娩镇痛方法的临床分析[J].浙江临床医学,2016,18(12):2322-2323.
[13]阎剑青.罗哌卡因与布比卡因在剖宫产手术腰-硬联合麻醉中的效果[J].中国药物与临床,2017,17(3):382-384.
[14]张勇.腰麻-硬膜外麻醉在老年患者股骨颈骨折手术中的应用观察[J].川北医学院学报,2016,31(4):589-592.
[15]孔松泉,包丽霞,蒋淑芬.不同麻醉方法对剖宫产围术期凝血功能及D-二聚体水平的影响[J].中国基层医药,2016,23(5):765-767.
[2]谭选军,申黎光,张川,等.腰硬联合麻醉与持续硬膜外麻醉用于剖宫产术的效果对比分析[J].陕西医学杂志,2015,44(2):180-182.
[3]杨敏.剖宫产采用腰硬联合与硬膜外麻醉术后镇痛效果临床对比研究[J].中国医药导刊,2016,18(6):599-601.
[4]董丽萍,蔡莉,刘虹,等.腰硬联合麻醉应用于无痛分娩的疗效及安全性分析[J].中国现代医学杂志,2015,25(3):91-93.
[5]何永冠,曹晓霞.硬膜外麻醉与腰硬联合麻醉在剖宫产术中的应用效果比较[J].中国急救医学,2016,36(z1):225-226.
[6]许斌.腰硬联合麻醉分娩镇痛48例效果观察及护理[J].齐鲁护理杂志,2015,21(6):33-34.
[7]Sviggum H P,Yacoubian S,Liu X,et al.The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia:a randomized controlled study[J].International Journal of Obstetric Anesthesia,2015,24(1):15-21.
[8]郝凤梅,苗华艳.氯普鲁卡因注射液联合吗啡注射液硬膜外麻醉对剖宫产术后镇痛的临床研究[J].中国临床药理学杂志,2017,33(2):112-115.
[9]李建宾,惠建伟,何婉雯,等.腰硬联合麻醉对剖宫产产妇围术期凝血功能、RAAS活性及术后镇痛效果的影响[J].国际检验医学杂志,2017,38(7):930-932,935.
[10]韩明,韩志强,王蕾,等.罗哌卡因用于腰硬联合麻醉及其扩散的研究进展[J].中国药物与临床,2016,16(4):527-529.
[11]Heesen M,Boehmer J,Kloehr S,et al.The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor,maternal,and neonatal outcomes:a systematic review and meta-analysis[J].Anesthesia and Analgesia:Journal of the International Anesthesia Research Society,2015,121(1):149-158.
[12]应震阳,黄晓东.第一产程活跃期减速期分娩镇痛方法的临床分析[J].浙江临床医学,2016,18(12):2322-2323.
[13]阎剑青.罗哌卡因与布比卡因在剖宫产手术腰-硬联合麻醉中的效果[J].中国药物与临床,2017,17(3):382-384.
[14]张勇.腰麻-硬膜外麻醉在老年患者股骨颈骨折手术中的应用观察[J].川北医学院学报,2016,31(4):589-592.
[15]孔松泉,包丽霞,蒋淑芬.不同麻醉方法对剖宫产围术期凝血功能及D-二聚体水平的影响[J].中国基层医药,2016,23(5):765-767.