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目的:研究自控连续硬膜外(PCEA)的分娩镇痛法,观察罗哌卡因与芬太尼用于分娩镇痛的有效性、安全性、运动神经阻滞情况,对产力、产程、分娩方式及母婴的影响。探讨分娩镇痛对降低剖宫产率,提高自然分娩率的意义。方法:对象为自愿接受分娩镇痛的ASAI级、经产科检查适合自然分娩,无硬膜外麻醉禁忌症的足月初产妇50例为研究组。随机选择相同条件未要求分娩镇痛的足月初产妇50例作为对照组。研究组于宫口开大至3cm时进行硬膜外穿刺置管,采用舒贝康一次性PCEA镇痛泵,泵内注入0.2%罗哌卡因+2?g/ml芬太尼的混合液;观察监测两组孕产妇的血压、脉搏、心电图、呼吸、血氧饱和度等生命体征,运动神经阻滞情况及不良反应、疼痛情况及VAS评分,两组均连接HPM1351A胎儿监护仪监测胎心率和子宫收缩情况。监测产程、分娩方式及失血量、新生儿Apgar评分,由麻醉医生进行分娩镇痛记录。宫口开全后停泵。第三产程结束后由麻醉医生拔除硬膜外导管。结果:研究组镇痛后的血压、脉搏、心电图、呼吸和血氧饱和度等生命体征无明显变化,给药后产妇主诉疼痛明显缓解,疼痛效果评分,有效率达100%,与对照组比较有明显差异。镇痛组第一产程比对照组明显缩短(P<0.05),第二产程两组比较无明显差异(P>0.05),失血情况两组无明显差异(P>0.05)。胎心率、新生儿Apgar评分两组钧无明显差异(P>0.05)。对照组剖宫产率明显高于镇痛组。结论0.2%罗哌卡因+2?g/ml芬太尼混合液用于自控连续硬膜外PCEA)分娩镇痛,镇痛效果好,能缩短产程、降低剖宫产率,不影响分娩方式、对母婴是安全可靠的,它具有临床的推广价值。
OBJECTIVE: To study the analgesia of labor produced by continuous controlled epidural (PCEA) and the effects of ropivacaine and fentanyl on labor analgesia, safety, motor nerve block, Mode of delivery and maternal and child effects. To explore the significance of labor analgesia to reduce the rate of cesarean section and improve the rate of natural childbirth. Methods: The subjects were ASAI who volunteered for analgesia during childbirth. Fifty cases of term full-term primipara suitable for natural childbirth without contraindication of epidural anesthesia were selected as study group. Randomly selected the same conditions did not require labor analgesia full-term primipara 50 cases as a control group. The study group in the cervix open up to 3cm epidural catheterization, the use of Shu Beikang disposable PCEA analgesic pump, pump 0.2% ropivacaine +2? G / ml fentanyl mixture ; Observing and monitoring the blood pressure, pulse rate, electrocardiogram, respiration, oxygen saturation and other vital signs, motor nerve block and adverse reactions, pain and VAS score of the two groups, both groups were connected with HPM1351A fetus monitor monitoring fetal heart rate Rate and uterine contractility. Monitoring labor, mode of delivery and blood loss, neonatal Apgar score, analgesia recorded by anesthesiologists. Miyaguchi open the whole stop pump. After the end of the third stage of labor, the anesthesiologist should remove the epidural catheter. Results: There was no significant change of vital signs such as blood pressure, pulse, electrocardiogram, respiration and oxygen saturation in the study group. After the administration, the pain of the main complaint was relieved and the pain effect was scored. The effective rate was 100%. Compared with the control group There are obvious differences. The first stage of labor in the analgesic group was significantly shorter than that in the control group (P <0.05). There was no significant difference in the second stage of labor between the two groups (P> 0.05). There was no significant difference in the blood loss between the two groups (P> 0.05). Fetal heart rate, neonatal Apgar score Jun two groups no significant difference (P> 0.05). Control group, cesarean section rate was significantly higher than the analgesic group. Conclusion 0.2% ropivacaine +2? G / ml fentanyl mixture for controlled continuous epidural PCEA) labor analgesia, analgesic effect, can shorten the labor process, reduce the rate of cesarean section, does not affect the mode of delivery , Is safe for maternal and child, it has the clinical promotion value.