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目的探讨在无痛分娩产程中镇痛泵的关闭时机。方法初产妇120例随机均分为两组:D组于胎盘娩出后关闭镇痛泵;C组在活跃期宫口开全后关闭镇痛泵。记录两组产妇的VAS疼痛评分、Bromage评分、产程时间、剖宫产和阴道助产指征、产后出血量、产后不良反应以及新生儿Apgar评分。结果两组产妇宫口开全前各时间点的VAS疼痛评分比较差异无统计学意义(P>0.05)。D组在会阴侧切和会阴缝合时的VAS疼痛评分低于C组(P<0.01)。D组第二产程短于C组[(45.9±20.5)min vs.(56.8±12.5)min](P<0.05)。两组Bromage评分均≤1分;D组Bromage评分为0分者占30.0%(18/60),低于C组的43.3%(26/60)(P<0.05)。两组产妇产后出血量比较差异无统计学意义(P>0.05)。两组新生儿Apgar评分均大于9分。两组产妇阴道助产、剖宫产、产后尿潴留、恶心呕吐、皮肤瘙痒及低血压的发生率比较差异无统计学意义(P>0.05)。结论硬膜外麻醉分娩镇痛时,于胎盘娩出后关闭镇痛泵可避免会阴侧切时疼痛,镇痛效果确切,对产程影响小,产妇下床活动不受影响,对母婴安全。
Objective To investigate the timing of the analgesia pump in labor during laborless labor. Methods 120 cases of primiparas were randomly divided into two groups: Group D was closed after the delivery of the analgesic pump placenta; C group in the active phase after the cervix opened analgesic pump. VAS pain score, Bromage score, labor time, cesarean section and vaginal birth induction, postpartum hemorrhage, postnatal adverse reactions and neonatal Apgar score were recorded. Results There was no significant difference in VAS pain score between the two groups before the cervix was opened (P> 0.05). VAS pain scores in group D at episiotomy and perineal suturing were lower than those in group C (P <0.01). The second stage of labor in group D was shorter than that in group C [(45.9 ± 20.5) min vs. (56.8 ± 12.5) min] (P <0.05). The Bromage scores of both groups were all ≤ 1 point. The score of Bromage in group D was 30.0% (18/60), which was lower than 43.3% (26/60) in group C (P <0.05). There was no significant difference in postpartum hemorrhage between the two groups (P> 0.05). Apgar scores in both groups were greater than 9 points. There was no significant difference in the incidence of vaginal delivery, cesarean section, postpartum urinary retention, nausea, vomiting, pruritus and hypotension between the two groups (P> 0.05). Conclusion Epidural anesthesia during labor analgesia, after the delivery of the placenta to close the analgesic pump to avoid pain during episiotomy, the analgesic effect is exact, the impact on labor is small, maternal out of bed activity is not affected, the mother and child safety.