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目的:探讨双管硬膜外阻滞镇痛联合心理疗法对分娩结局的影响。方法:选择黔南布依族苗族自治州人民医院产科2008年1月~2010年12月单胎、足月、初产妇160例,随机分成4组,双管硬膜外阻滞组(以下简称DCEA组)、心理疗法组、双管硬膜外阻滞+心理疗法组(以下简称DCEA+心理疗法组)和对照组。分别观察4组产妇SAS评分评价焦虑度、疼痛视觉模拟VAS评分、采用改良的Bromage评价运动阻滞情况、镇痛混合液总量、新生儿Apgar 1 min及5 min评分、分娩方式、血浆血管紧张素Ⅱ、皮质醇水平及产妇麻醉相关并发症的发生情况。结果:①DCEA+心理疗法组入产室SAS评分分别与其他3组比较,有统计学意义(P<0.01);②DCEA+心理疗法组在宫口扩张至5 cm及宫口扩张至10 cm时VAS评分分别与其他3组比较,有统计学意义(P<0.01);③DCEA组和DCEA+心理疗法组Bromage评分分别与心理疗法组和对照组比较,有统计学意义(P<0.05);④DCEA+心理疗法组缩宫素使用率、总产程时间及第二产程时间与其他3组比较,有统计学意义(P<0.01);⑤DCEA+心理疗法组宫缩间隔时间和宫缩持续时间分别与心理疗法组和对照组比较,有统计学意义(P<0.05);⑥4组新生儿脐血pH、PO2、PCO2水平比较,无统计学意义(P>0.05);⑦DCEA+心理疗法组分娩方式和剖宫产指征分别与心理疗法组和对照组比较,有统计学意义(P<0.05);⑧DCEA+心理疗法组在宫口扩张至10 cm及胎儿娩出时血浆血管紧张素Ⅱ、皮质醇水平与心理疗法组和对照组比较,有统计学意义(P<0.05);⑨DCEA组产妇总体满意率为80.00%、心理疗法组为65.00%、DCEA+心理疗法组为100.00%、对照组为40.00%,DCEA+心理疗法组产妇总体满意率与其他3组比较,有统计学意义(P<0.01)。结论:双管硬膜外阻滞联合心理疗法用于产妇分娩镇痛,可强化镇痛效果并减少用药量,对分娩结局无不良影响。
Objective: To investigate the effect of double-tube epidural analgesia combined with psychological therapy on delivery outcome. Methods: One hundred fetus, term full-term and primipara of obstetrics of People’s Hospital of Qiannan Buyi and Miao Autonomous Prefecture from January 2008 to December 2010 were randomly divided into 4 groups: double-ended epidural block (hereinafter referred to as DCEA group ), Psychological therapy group, double-tube epidural block + psychological therapy group (hereinafter referred to as DCEA + psychological therapy group) and control group. The SAS anxiety scores and visual analog VAS scores of the four groups were observed. The modified Bromage was used to evaluate the motor block, the total amount of analgesic mixture, neonatal Apgar 1 min and 5 min score, mode of delivery, and plasma vascular tension Hormone Ⅱ, cortisol levels and maternal anesthesia related complications. Results: (1) The SAS scores of DCEA + psychotherapy group were statistically different from those of the other three groups (P <0.01); ②DCEA + psychotherapy group were significantly different (P <0.01); (3) The Bromage score of DCEA group and DCEA + psychotherapy group were significantly lower than that of psychological therapy group and control group (P <0.05); ④DCEA + psychological therapy group Uterine hormone utilization rate, total labor duration and the second stage of labor time compared with the other three groups were statistically significant (P <0.01); ⑤DCEA + psychological therapy group contractions and uterine contractions duration and psychological therapy group and control group (P <0.05); ⑥No umbilical cord blood pH, PO2, PCO2 levels of neonates in 4 groups were compared, there was no statistical significance (P> 0.05); ⑦DCEA + psychotherapy group mode of delivery and cesarean section indications were (P <0.05); ⑧DCEA + psychological therapy group in the cervix to 10 cm dilatation and fetal delivery of plasma angiotensin Ⅱ, cortisol levels compared with the psychological therapy group and the control group , With statistical significance (P <0.05); ⑨DCEA group maternal total The satisfaction rate was 80.00% in the psychotherapy group, 65.00% in the psychotherapy group, 100.00% in the DCEA + psychotherapy group and 40.00% in the control group. The overall satisfaction rate of the maternal women in the DCEA + psychotherapy group was statistically significant (P <0.01) . Conclusion: The combination of double-tube epidural block and psychotherapy for labor analgesia can enhance the analgesic effect and reduce the dosage, which has no adverse effect on delivery outcome.