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椎管内阻滞分娩镇痛时产妇宫缩疼痛程度对剖宫产率的影响

  • 摘要: 目的:探讨椎管内阻滞用于分娩镇痛时产妇宫缩疼痛程度对剖宫产率的影响。方法:选择单胎、头位、宫口<4 cm,无产科并发症产妇590例,根据数字评分量表(NRS)评分,将其分为3组:L(1~4分)组、M(5~7分)和H(8~10分)组。产妇均于腰2~3或腰3~4间隙进行硬膜外穿刺。行硬膜外镇痛者硬膜外腔给予实验剂量1.0%碳酸利多卡因5 mL,待阻滞平面出现后给予负荷剂量0.1%罗哌卡因复合5 μg舒芬太尼混合液10 mL,观察30 min无不良反应后连接患者自控硬膜外镇痛泵(PCEA)。行CSEA镇痛者硬膜外穿刺成功后蛛网膜下隙注入0.1%罗哌卡因复合3 μg舒芬太尼混合液3 mL,90 min后连接PCEA。观察并记录行镇痛前产妇的NRS评分;第一产程时间、第二产程时间和分娩方式。结果:3组间镇痛后30 min NRS评分、宫口大小、第一产程时间、第二产程时间组间比较差异无统计学意义;3组间产钳助产率和剖宫产率比较差异无统计学意义。结论:椎管内阻滞分娩镇痛时产妇的宫缩疼痛程度对剖宫产率无明显影响。

     

    Abstract: Objective:To assess the degree of labor pain at the time of intraspinal labor analgesia in women influencing the incidence of cesarean delivery. Methods:Five hundred and ninety patients were enrolled in the study and divided into 3 groups in the light of numeric rating scale (NRS). The woman was with singleton pregnancies, with cervical dilatation of less than 4 cm and vertex fetal presentations. Namely, L group:1-4;M group:5-7;H group:8-10, respectively. The EA procedure was performed at the lumbar spine between 2-3 or 3-4. We inserted a catheter into the epidural space started with 1.0% carbonated Lidocaine to make the volume 5 mL. After the block plane arising, injected a mixture of 0.1% Ropivacaine co-administered with 5 μg of Sufentanil to make the total volume 10 mL in all cases, and connected the patient controlled epidueal analgesia (PCEA) thirty minutes later. The CSEA procedure was started with an intrathecal standard mixture of 0.1% Ropivacaine co-administered with 3 μg of Sufentanil to make the total volume 3 mL in all cases, then connected the PCEA ninety minutes later. To observe and record the NRS score when analgesia was performed. The time of the first stage of labor, the time of the second stage of labor and the way of delivery were recorded in our study respectively. Results:There was no statistically significant differences among the three pain groups in the NRS score after 30 min, dilatation, duration of first stage of labor and duration of second stage of labor, respectively. There was no statistically significant differences among the three pain groups in the incidence of instrumental delivery and cesarean delivery. Conclusions:There is no effect of the degree of labor pain at the time of intraspinal labor analgesia in women on the incidence of cesarean delivery.

     

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