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目的探讨硬膜外神经阻滞与低剂量盐酸哌替啶复合咪唑安定在分娩镇痛中效果和安全性。方法选取2013年1月-2014年12月间在该院足月正常产的312例产妇,按照病案号的单双号将入选产妇分为观察组和对照组,每组各156例。观察组产妇给予静脉注射小剂量盐酸哌替啶和安定镇痛分娩;对照组产妇给予硬膜外阻滞麻醉镇痛分娩。比较2组产妇的镇痛效果、产程、产后出血量、新生儿Apgar评分、抑郁自评(SDS)、焦虑自评(SAS)、分娩后1个月内不良反应情况。结果观察组产妇无疼痛感的比例为31.41%,对照组产妇为32.05%,2组比较差异无统计学意义(χ2=0.106,P>0.05);2组均无强烈疼痛和极度疼痛的产妇。第一产程时间、第二产程时间2组产妇差异均无统计学意义(t值分别为0.607、0.229,均P>0.05);2组产妇产后出血量、新生儿Apgar评分之间差异均无统计学意义(χ2值分别为0.438、0.831,均P>0.05)。观察组产妇SDS评分和SAS评分均明显低于对照组产妇,差异有统计学意义(t值分别为10.339、9.634,均P<0.01)。观察组分娩后1个月内有2例出现下肢疼痛;对照组分娩后1个月内3例出现下肢疼痛,2例出现头晕、麻木;对照组产妇不良反应发生率明显高于观察组,差异有统计学意义(χ2=9.143,P<0.05)。结论低剂量盐酸哌替啶复合咪唑安定的分娩镇痛效果与硬膜外神经阻滞无明显差异,但可明显改善产妇自身情绪,具有较高的安全性,具有在临床中实际推广使用的价值。
Objective To investigate the efficacy and safety of epidural block and low dose of pethidine hydrochloride combined with midazolam in labor analgesia. Methods A total of 312 maternal normal women were enrolled in this hospital from January 2013 to December 2014, and the selected mothers were divided into observation group and control group according to the single and double numbers of the case number. Each group included 156 cases. The observation group maternal intravenous injection of low dose of pethidine hydrochloride and stable analgesia childbirth; control group of women given epidural anesthesia analgesia childbirth. Analgesia, labor, postpartum hemorrhage, neonatal Apgar score, SDS, anxiety self-assessment (SAS), adverse reactions within 1 month after delivery were compared between the two groups. Results The proportion of maternal painlessness was 31.41% in the observation group and 32.05% in the control group. There was no significant difference between the two groups (χ2 = 0.106, P> 0.05). There were no severe pain and extreme pain in the two groups. There was no significant difference between the two groups (t = 0.607, 0.299, respectively, P> 0.05). There was no statistical difference between the two groups in postpartum hemorrhage and neonatal Apgar scores Significance (χ2 values were 0.438,0.831, all P> 0.05). The SDS scores and SAS scores of the observation group were significantly lower than those of the control group, the difference was statistically significant (t = 10.339, 9.634, all P <0.01). In the observation group, 2 cases showed lower limb pain within 1 month after delivery. In the control group, 3 cases showed lower limb pain within 1 month after delivery and 2 cases showed dizzy and numbness. The incidence of adverse reactions in the control group was significantly higher than that in the observation group There was statistical significance (χ2 = 9.143, P <0.05). Conclusion The low dose of pethidine hydrochloride combined with midazolam did not show any significant difference in analgesia between labor and epidural anesthesia, but it could significantly improve maternal self-esteem with higher safety and practical value in clinical practice .