吕宁 吕艳 李莉

[摘要] 目的 比較全产程硬膜外分娩镇痛与经皮神经电刺激联合硬膜外阻滞全产程分娩镇痛的安全性及有效性。 方法 选择2016年12月～2017年12月在天津市中心妇产科医院分娩的产妇200例为研究对象，采用随机数字表法分为全产程硬膜外分娩镇痛组（B组）和经皮神经电刺激联合硬膜外阻滞全产程分娩镇痛组（C组），每组各100例。剔除中转剖宫产的产妇后，B组最终纳入85例，C组纳入93例。B组产妇自潜伏期（规律宫缩）即实施硬膜外分娩镇痛，C组产妇于潜伏期行经皮神经电刺激镇痛，进入活跃期（宫口开3cm）同时行硬膜外阻滞镇痛，方法同B组。分别记录两组产妇实施镇痛后宫口开2、4、6、8 cm和10 cm的疼痛视觉模拟评分（VAS）；记录各组产妇第一产程时间及两组新生儿脐动脉血pH值、二氧化碳分压、氧分压、乳酸、剩余碱（BE）值及娩出后l min的Apgar评分。 结果 B组产妇剖宫产率高于C组，第一产程时间长于C组，差异均有统计学意义（P < 0.05）。宫口开2 cm时B组VAS评分低于C组（P < 0.05）；宫口开4 cm和6 cm时两组VAS评分比较，差异无统计学意义（P > 0.05）；宫口开8 cm和10 cm时B组VAS评分高于C组，差异有高度统计学意义（P < 0.01）。两组新生儿出生后1 min的Apgar评分及脐带动脉血血气分析比较，差异无统计学意义（P > 0.05）。 结论 经皮神经电刺激联合硬膜外阻滞全产程分娩镇痛可安全有效地应用于顺产产妇。

[关键词] 分娩镇痛；电刺激；新生儿

[中图分类号] R741 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0094-04

The safety and efficacy of the whole stage electrical stimulation combined with epidural labor analgesia

LYU Ning LYU Yan LI Li

Department of Anesthesiology， Tianjin Central Obstetrics and Gynecology Hospital， Tianjin 300100， China

[Abstract] Objective To compare the safety and efficacy of the whole stage epidural labor analgesia and whole stage electrical stimulation combined with epidural labor analgesia. Methods From December 2016 to December 2017， a total of 200 cases of puerperas in Tianjin Central Obstetrics and Gynecology Hospital were selected as the research objects and divided into the whole stage epidural labor analgesia group （group B） and the whole stage electrical stimulation combined with epidural labor analgesia group （group C） by the random number table， with 100 cases in each group. The puerperas who received caesarean section were eliminated， with 85 cases in group B and 93 cases in group C. Group B was given epidural labor analgesia in the latent phase （after uterine contractions regularly）， group C was given electrical stimulation in incubation period of first production process and epidural labor analgesia after uterine contractions regularly as in group B （when the uterus cervix was 3 cm）. The time for the first stage of labor and the scores of visual analogue scale （VAS） at the uterus cervix 2， 4， 6， 8 cm and 10 cm were recorded. The blood gas analysis of umbilical artery of neonates （includes pH value， carbon dioxide partial pressure， oxygen partial pressure， lactic acid， residual alkali.） and the Apgar score after 1 min of delivery were recorded. Results The cesarean section rate in group B was higher than that of group C， the first stage of labor time in group B was longer than that of group C， with statistically significant differences （P < 0.05）. At the uterine cervix 2 cm， the VAS score in group B was lower than that of group C， with statistically significant difference （P < 0.05）. There were no statistically significant differences at the uterine cervix 4 cm and 6 cm between the two groups（P > 0.05）. At the uterine cervix 8 cm and 10 cm， the VAS scores in group B were higher than those of group C， with statistically significant differences （P < 0.01）. There were no statistically significant differences between the two groups in the blood gas analysis of umbilical artery and the 1 min Apgar score after birth （P > 0.05）. Conclusion The whole stage electrical stimulation combined with epidural labor analgesia is safe and effective for puerperas with natural labor.

[Key words] Labor analgesia； Electrical stimulation； Neonate

产痛在医学疼痛指数上排名居第二位，是绝大多数女性一生中经历的最为剧烈的疼痛[1]。产痛所产生的一系列体内神经和内分泌反应，可引起胎儿和母体的各种机能和代谢的改变[2]。国内分娩镇痛多采用硬膜外阻滞镇痛，国内外学者证实，硬膜外麻醉用于分娩镇痛是安全有效的[3]，一般实施于第一产程活跃期，而第一产程潜伏期的疼痛虽不及活跃期明显，但仍会对产妇心理和生理产生不良影响。……