国际妇产科学杂志

国际妇产科学杂志 ›› 2018, Vol. 45 ›› Issue (2): 145-149.

• 论著 • 上一篇    下一篇

全产程多模式分娩镇痛对母婴安全的影响

李莉，吕艳，翟翔隽，崔洪艳   

  1. 300100  天津市中心妇产科医院麻醉科（李莉），妇产科（吕艳，翟翔隽，崔洪艳）
  • 收稿日期:2018-01-02 修回日期:2018-03-23 出版日期:2018-04-15 发布日期:2018-04-15
  • 通讯作者: 崔洪艳，E-mail：cuihy9828@163.com E-mail:cuihy9828@163.com
  • 基金资助:
    天津市卫生行业重点攻关项目（16KG112）

The Effect of Multimodal Analgesia in Total Stage of Labor on Maternal and Infant Safety

LI Li，LYU Yan，ZHAI Xiang-jun，CUI Hong-yan   

  1. Department of Anesthesiology（LI Li），Department of Obstetrics and Gynecology（LYU Yan，ZHAI Xiang-jun，CUI Hong-yan），Tianjin Central Hospital of Gynecology Obstetrics，Tianjin 300100，China
  • Received:2018-01-02 Revised:2018-03-23 Published:2018-04-15 Online:2018-04-15
  • Contact: CUI Hong-yan，E-mail：cuihy9828@163.com E-mail:cuihy9828@163.com

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摘要： 目的：探讨全产程多模式分娩镇痛对母婴安全的影响。方法：足月、单胎、头位初产妇300例，年龄23～36岁，身高155～172 cm，体质量61～95 kg，孕38～41周，采用随机数字表法将其分为3组：活跃期硬膜外阻滞镇痛组（A组，n=100）、全产程硬膜外阻滞镇痛组（B组，n=100）和经皮神经电刺激（TENS）联合硬膜外阻滞全产程镇痛组（C组，n=100）。记录各组产妇不同时点视觉模拟评分（VAS）、产程时间、产后出血量、催产素使用率及新生儿Apgar评分、脐动脉血血气分析结果；并于临产后（T0）、宫口开全时（T1）取静脉血测β-内啡肽（β-EP）、去甲肾上腺素（NE）、肾上腺素（E）和血糖浓度。结果：B、C 2组产妇潜伏期（宫口≤3 cm）各时点VAS评分低于A组，差异有统计学意义（均P＜0.05）。A、C 2组产妇第一产程时间和催产素使用率均低于B组，差异有统计学意义（均P＜0.05）。3组新生儿Apgar评分和脐动脉血血气结果比较，差异无统计学意义（均P＞0.05）。与T0时比较，3组产妇T1时血β-EP、NE、E和血糖浓度均升高，差异有统计学意义（均P＜0.05）。C组产妇T1时β-EP浓度较A、B 2组升高，B、C 2组 NE、E和血糖浓度较A组降低，差异有统计学意义（均P＜0.05）。结论：全产程多模式分娩镇痛在保证产妇镇痛效果的基础上，降低了催产素使用率且不影响产程及围生儿结局，对母婴安全起到保护作用。

关键词: 镇痛, 产科, 镇痛, 硬膜外, 经皮神经电刺激, 针刺穴位, 产程

Abstract: Objective：To investigate the effect of multimodal analgesia in total stage of labor on maternal and infant safety. Methods：300 full-term pregnant woman with single fetuses, aged 23-36 yr, weighing 61-95 kg, whose height were between 155-172 cm and have been pregnant for 38-41 weeks, were randomly divided into three groups: epidural anesthesia labor analgesia in active period (Group A, n =100), epidural anesthesia labor analgesia in total stage of labor (Group B, n =100) and TENS combined with epidural anesthesia labor analgesia in total stage of labor (Group C, n=100). VAS scores at different time, labor time, volume of postpartum hemorrhage, the rate of using pitocin, Apgar score and blood gas analysis to fetal umbilical blood were recorded. Blood samples were taken from three groups at the time of labor (T0) and complete cervical dilation (T1) to test the concentrations of β-endorphin, norepinephrine, epinephrine and blood sugar. Results：The VAS scores of group B, C at each point in incubation period of labor, were significantly lower than those of group A(P＜0.05). The first stage of labor and the rate of using pitocin in group A, C were shorter than those in group B (P＜0.05). There was no significant difference in the volume of postpartum hemorrhage, Apgar score and blood gas analysis of fetal umbilical blood in three groups (P＞0.05). Compared with T0, the concentrations of blood β-endorphin, norepinephrine, epinephrine and blood sugar in three groups significantly increased at T1 (P＜0.05). The concentration of β-endorphin at T1 was significantly higher in group C than that in group A and group B (P＜0.05). Norepinephrine, epinephrine and blood sugar concentrations in group B and group C were lower than those in group A (P＜0.05). Conclusions：Multimodal labor analgesia in total stage of labor can reduce the rate of using pitocin, avoid influences on stage of labor and the outcome of perinatal, protecting the safety of maternal and infant while improving the effect of labor pain in the first place.

Key words: Analgesia, obstetrical, Analgesia, epidural, Transcutaneous electric nerve stimulation, Acupuncture points, Stage of labor