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目的探讨全产程硬膜外阻滞进行分娩镇痛对子宫收缩和产程的影响,评估全产程硬膜外分娩镇痛的安全性和可行性。方法自2011年12月至2012年10月要求行分娩镇痛的初产妇105例,分为观察组(52例)和对照组(53例)。观察组在临产宫口开大1cm是实施硬膜外分娩镇痛,对照组未实施分娩镇痛。观察组产妇使用0.1%罗哌卡因复合0.5μg/mL舒芬太尼的混合液作为镇痛药物,镇痛延续至分娩后10h。记录镇痛前、镇痛后5、10、20、30、60、120min、宫口开全、第二产程、第三产程、产后10h宫缩的频率和宫缩持续的时间。记录第一产程潜伏期和活跃期、第二产程和第三产程时间。记录产程分娩方式:阴道自然分娩,阴道器械助产,剖宫产。记录催产素的使用。结果①组内比较:观察组组内与T0相比,T2、T3、T4时宫缩频率降低且宫缩持续时间缩短(P<0.05);组间比较:T2、T3、T4、T5时2组的宫缩频率和宫缩持续时间差异具有统计学意义(P<0.05),T6、T7、T8、T9、T10时2组的宫缩频率和宫缩持续时间差异无统计学意义(P>0.05)。②2组间各产程时间比较差异无统计学意义(P>0.05);③2组产妇均在严密监测下合理使用催产素,催产素的使用比较差异有统计学意义(P<0.05),观察组器械助产率高于对照组差异无统计学意义(P>0.05),观察组剖宫产率低于对照组差异有统计学意义(P<0.05)。结论全产程硬膜外分娩镇痛对宫缩和产程无明显影响,对新生儿及产妇安全可行,值得推广。
Objective To investigate the effect of labor-induced epidural block on labor and uterine contractions during labor and evaluate the safety and feasibility of labor-wide epidural analgesia during labor. Methods 105 cases of primipara caused by labor analgesia from December 2011 to October 2012 were divided into observation group (52 cases) and control group (53 cases). The observation group in the labor cervix open 1cm is the implementation of epidural analgesia, the control group did not implement childbirth analgesia. The observation group maternal 0.1% ropivacaine combined with 0.5μg / mL sufentanil mixture as analgesics, analgesic until 10h after delivery. Record analgesia before and after analgesia 5,10,20,30,60,120 min, cervix open whole, the second stage of labor, the third stage of labor, postpartum 10h contractions frequency and duration of contractions. Record the first stage of labor latency and active period, second stage and third stage of labor time. Record labor delivery mode: natural vaginal delivery, vaginal device midwifery, cesarean section. Record the use of oxytocin. Results ① In-group comparison: Compared with T0, the frequency of uterine contractions and the duration of uterine contractions in T2, T3, T4 decreased in observation group (P <0.05) (P <0.05). There was no significant difference in contractile frequency and duration of uterine contractions between the two groups at T6, T7, T8, T9 and T10 (P> 0.05). There was no significant difference in the duration of labor between the two groups (P> 0.05); ③ The use of oxytocin was closely monitored in the second group of maternal women, the use of oxytocin was significantly different (P <0.05) The rate of midwifery was higher than that of the control group (P> 0.05). The rate of cesarean section in the observation group was lower than that of the control group (P <0.05). Conclusion Full-term epidural analgesia has no significant effect on uterine contractions and labor, and is safe and feasible for newborns and mothers. It is worth promoting.