赵燕峰　李斌　欧阳雨芳

[摘要] 目的 探討硬膜外预置管阻滞用于经产妇分娩镇痛的有效性、及时性、安全性，提高经产妇分娩镇痛率和质量。方法 选择 2013 年 5 月～2014 年 10 月我院住院待产的足月经产妇 270例为研究对象，根据研究要求分为三组，其中观察组（A组）运用PCEA的分娩镇痛方式；对照1组（B组）运用连续硬膜外分娩镇痛；对照2组（C组）未经分娩镇痛，观察三组产妇的生命体征、胎心，记录第一、二、三产程时间及疼痛的视觉模拟评分（VAS评分）、Bromage评分、分娩方式、缩宫素使用率、新生儿Apgar评分、产妇出血量、会阴裂伤发生率等。 结果 三组产妇的一般资料如年龄、身高、体重、孕周比较，差异均无统计学意义（P>0.05）；三组的产程、会阴裂伤发生率相比差异有统计学意义（P<0.05）；观察组和对照1组在缩宫素使用率、剖宫产率、新生儿窒息率评分、产后出血量方面差异无统计学意义（P>0.05）；观察组与对照2组在缩宫素使用率、剖宫产率、新生儿窒息率评分、产后出血量比较有统计学意义（P<0.05）。 结论 连续硬膜外预置管法阻滞用于经产妇分娩镇痛安全有效，可以提高对产科并发症的手术麻醉处理的及时性、有效性，减少会阴裂伤发生率，增加经产妇分娩的安全性 。

[关键词] 预置管；经产妇；分娩镇痛；硬膜外

[中图分类号] R714.3 [文献标识码] B [文章编号] 1673-9701（2015）35-0113-04

[Abstract] Objective To investigate the validity， timeliness and security of epidural preset tube to block multipara labor analgesia， and to improve maternal labor analgesia rates and quality. Methods A total of 270 cases of mature maternal in our hospital from May 2013 to October 2014 were chosen for the study， according to the study requirements， and they were divided into three groups. The observation group（group A） received PCEA labor analgesia method， and the control group1 （group B） received continuous epidural labor analgesia method， and the control group 2 （group C） did not undergo analgesia. Maternal vital signs and fetal heart rate in the three groups were observed， and the first stage of labor， the second stage of labor and the third stage of labor， pain visual analog scale （VAS score）， Bromage score， mode of delivery， oxytocin usage rate， newborn Apgar score， maternal hemorrhage amount and the incidence of perineal laceration were recorded. Results There were not statistically significant differences in comparing general information of the 3 groups such as age， height， weight， gestational age（P>0.05）. The differences in stage of labor and the incidence of perineal laceration in the three groups were statistically significant （P<0.05）. The differences were not statistically significant in comparing oxytocin usage rate， cesarean section rate， neonatal asphyxia score， postpartum hemorrhage amount of the observation group and the control group 1 （P>0.05）. The differences were statistically significant in comparing oxytocin usage rate， cesarean section rate， neonatal asphyxia score and postpartum hemorrhage amount in the observation group and the control group 2 （P<0.05）. Conclusion Continuous epidural preset tube method to block maternal labor analgesia is safe and effective， can improve the timeliness and effectiveness of obstetric complications anesthesia process， reduce the incidence of perineal laceration， and increase maternity delivery security.

[Key words] Preset tube； Multipara； Labor analgesia； Epidural

由于国家政策或家庭特殊原因，经产妇在产妇中的比例呈增加的趋势，分娩镇痛的规模化推广，运用于经产妇的经验逐渐建立，目前我院初产妇的分娩镇痛率81.3%，经产妇的分娩镇痛率51.8%，为分析经产妇产程特点及生理、心理因素等，本研究近期对经产妇90例采用硬膜外预置管法行分娩镇痛，旨在改善经产妇分娩质量，现报道如下。

1 资料与方法

1.1 临床资料

选择2013年5月～2014年10月我院住院待产的足月经产妇 270例，孕周38～41周，年龄（35.1±5.0）岁，单胎头先露无妊娠合并症，排除有剖宫产指征和硬膜外阻滞禁忌证，产前检查适合从阴道分娩，ASA 分级Ⅰ～Ⅱ。A组……