摘要
目的探讨在基层医院分娩镇痛临床应用的可行性及推广模式。方法选择排除产科及麻醉禁忌证的单胎头位足月产妇(ASAI-Ⅱ级)2 000例,自愿接受分娩镇痛A组964例:采用腰硬联合(CSEA+PCEA)镇痛,B组:静脉镇痛(PCIA)371例(为常规产科处理宫口开至大于6 cm后要求镇痛者),C组:常规产科处理665例,3组均同时予导乐分娩。结果 A组VAS由镇痛前(5.9±1.3)分很快降至(1.1±0.4)分(P<0.01),B组由镇痛前(9.5±0.4)分很快降至(3.3±1.2)分(P<0.01)。剖宫产率A组15.7%、B组13.3%,与C组54.36%相比下降(P<0.01);各组下肢运动、产程、催产素应用率、器械助产率相比较,差异均无统计学意义(P>0.05)。无胎儿宫内窘迫或新生儿呼吸抑制发生、无产妇循环抑制、镇静过度或低氧血症发生。结论产妇行CSEA+PCEA及PCIA分娩镇痛,均效果显著,可有效降低剖宫产率,提高自然分娩率,对母婴安全有益,是一种安全有效的分娩镇痛方式。
Objective To explore the feasibility and extension mode of clinical application of delivery analgesia in primary hospital. Methods 2 000 cases with single fetal head position and full-term pregnant women （ASAⅠ-Ⅱ） were excluded from obstetrical and anesthesia contraindications. Group A analgesia was performed in 964 patients in group CSEA＋PCEA, Group B： intravenous analgesia （PCIA） was performed in 371 patients （for routine obstetric treatment, and the cervix was opened to more than 6 cm after analgesia）, Group C： 665 cases were treated by routine obstetrics, the 3 groups were also given doula delivery. Results In group A, VAS decreased rapidly （1.1± 0.4） before analgesia （5.9±1.3） （P〈0.01）. The B group was quickly dropped to （3.3± 1,2） points before analgesia （9.5±0.4） （P〈0.01）. The rate of caesarean section was 15.7% in group A and 13.3% in group B, which was lower than that 54.36%in group C （P〈0.01）; There was no significant difference in the movement, labor process, the rate of oxytocin application and the rate of medical delivery between the two groups （P〉0.05）. No fetal distress or neonatal respiratory depression, no maternal circulatory suppression, excessive sedation or hypoxemia occurred. Conelusion The effect of CSEA＋PCEA and PCIA labor analgesia on parturient women is remarkable, the utility model can effectively reduce the cesarean section rate, improve the natural childbirth rate, is beneficial to the safety of mother and baby, and is a safe and effective method of labor analgesia.
出处
《中国继续医学教育》
2017年第12期90-92,共3页
China Continuing Medical Education
关键词
基层医院
分娩镇痛
临床应用
推广模式
primary hospital
labor analgesia
clinical application
extension model
