腰麻复合硬膜外阻滞和笑气吸入用于无痛分娩的效果评估

Evaluating effects of combined spinal and epidural anesthesia and nitrous oxide inhalation used in labour analgesia

摘要:

目的腰麻复合硬膜外阻滞(CSEA)和笑气吸入无痛分娩的效果评估.方法90名足月初产孕妇随机分为实验组Ⅰ、实验组Ⅱ及对照组,前两组孕妇宫口开至3 cm后,分别行CSEA及笑气吸入分娩镇痛,监测镇痛效果、产程各指标及测定β-内啡肽(β-EP).结果实验组镇痛效果好于对照组,而实验组Ⅰ镇痛效果好于实验组Ⅱ.实验组Ⅰ活跃期短于对照组活跃期,实验组Ⅱ潜伏期后各产程均短于对照组.实验组Ⅰ与Ⅱ各产程无明显差异.宫缩强度、产钳率、剖宫产率、产后出血,胎儿窘迫、新生儿Apgar评分,三组无显著性差异.三组产妇β-EP浓度时均高于产后.产时β-EP实验组Ⅰ最低,实验组Ⅱ与对照组无差异;而产后β-EP实验组Ⅱ最高.结论CSEA及笑气吸入用于分娩镇痛,能缓解产痛,缩短产程,不影响产程中各因素.β-EP在分娩应激状态下升高,产后显著下降,提示β-EP参与分娩镇痛.

Abstract:

Objective: To evaluate effects of combined spinal and epidural anesthesia (CSEA) and nitrous oxide (N2O) inhalation used in labour analgesia. Methods: Ninety nulliparous women at term were randomly divided into three groups: study group Ⅰ, study group Ⅱ and control group. In the study two groups, CSEA and N2O inhalation were applied separately when cervix dilated 3 cm. Observed labour process, recorded analgesic effect, then drew maternal intravenous blood for β-EP determination. Results: The two study groups had a good effect on relieving labour pain, and the study group Ⅰ had better effect than the study group Ⅱ. In the study group Ⅰ, the active phase was shorter than that of the control group; and in the study group Ⅱ, the active phase, the second stage, the third stage and the total stage were all shorter than those of the control group. Between the study group Ⅰ and Ⅱ, there was no difference in labour duration. There was no difference about uterine contraction among the three groups, rate of spontaneous delivery, delivery forceps and cesarean section, postpartum hemorrhage volume, fetal distress and neonatal Apgar Scores. The concentration of β-EP in the three groups at delivery were all higher than those of postpartum. At delivery, the concentration of β-EP of the study group Ⅰ was the lowest; after delivery, the concentration of β-EP in the study group Ⅱ was the highest. Conclusions: CSEA and N2O inhalation can be applied in labour analgesia, relieving labour pain,decreasing labour duration, not influencing other labour factors. At delivery, the concentration of β-EP is sig nificantly increased, however decreased greatly after delivery, which indicated that β-EP took part in the labour analgesia.