持续硬膜外麻醉在无痛分娩中的应用.doc

持续硬膜外麻醉在无痛分娩中的应用 作者：杨萍 单位：617200 四川 攀枝花，米易县人民医院妇产科(杨 萍) 【摘要】目的 探讨小剂量复合药物持续硬膜外麻醉在分娩镇痛中的应用效果。方法 选择245例无硬膜外穿刺禁忌症，无胎儿宫内窘迫征象，无产科及内外科并发症，可经阴道分娩的初产妇，随机分为观察组125例对照组120例。采用硬膜外麻醉进行分娩镇痛，观察产程时间、分娩方式。结果 两组镇痛效果比较有显著性差异(Plt;0.01)，观察组镇痛效果优于对照组。结论 小剂量复合药物镇痛作用快，效果安全可靠，对母婴无不良影响。可以减轻软产道对胎头的阻力，从而达到加速完成分娩过程,减轻孕妇分娩痛苦的作用。 【关键词】 分娩镇痛; 持续硬膜外麻醉 The Application of Continuous Epidural Anesthesia in Painless LaborYang Ping, Department of Obstetrics and Gynecology, the Peoplersquo;s Hospital of Miyi County, Panzhihua City, Sichuan Province 617200 　　ABSTRACT Objective To discuss the application effect of continuous epidural anesthesia with small dosage of complex drugs in painless labor. Methods 245 primipara with no contraindication of epidural puncture, no fetal distress in uterus, no obstetric or surgical complications and suitable for vaginal delivery were selected and randomly divided into 2 groups: observation group (n=125) and control group (n=120); epidural anesthesia was performed for labor analgesia; the time of labor duration and labor mode were observed Results The analgesia effect in observation group was much superior to that in control group, the difference between the 2 groups was significant (Plt;0.01). Conclusions Analgesia with small dosage of complex drugs is effective, safe and reliable with no side effect on mother and infant, and it can reduce the resistance of the soft birth canal to infant head so as to fasten the delivery process. 　　KEYWORDS labor analgesia continuous epidural anesthesia 　　分娩疼痛是分娩过程中的生理现象,但严重的产痛能给产妇造成恐惧感,使身心受到刺激而产生不良心理反应，为减轻产妇在分娩时的疼痛，保证母子平安，进一步做好优生、优育， 2007年10月至2008年10月我院对125例正常足月临产的孕妇,全产程持续硬膜外麻醉行无痛分娩取得满意的效果，现报告如下。 　　1 资料与方法 　　1.1 一般资料 两组年龄均在20～35岁,胎龄38～41周，初产妇 165例,经产妇80例。观察组125例，选择足月、单胎、产前检查无阴道分娩禁忌，无硬脊膜外腔阻滞(EB)禁忌，自愿要求行无痛分娩，且无产科及内科重大并发症的产妇。对照组120例，未用任何止痛措施。 　　1.2 方法 观察组于第一产程(T1)宫口开大至2cm时，经L2～L3或L3～L4椎间隙行常规硬膜外腔穿刺并向头置管4～5cm。平卧后先硬膜外腔注射0.7%利多卡因3～5ml，观察5min后，无全脊麻及局麻药中毒征象，用针刺法测试麻醉绝对阻滞平面在T10以下，相对阻滞平面在T8以下，然后根据病人对宫缩痛的反应情况再注入0.125%布比卡因+芬太尼2mu;g/ml的混合镇痛液5～7ml，首次局