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目的探讨笑气(氧化亚氮)吸入与硬膜外阻滞用于分娩镇痛方法的镇痛效果及对母婴的影响。方法2003年5月至10月在深圳市南山妇幼保健院住院的单胎、头位、足月临产的初产妇,行笑气吸入镇痛120例,行低浓度罗哌卡因+芬太尼硬膜外阻滞镇痛150例,并与同期未使用镇痛药物单胎、头位、足月临产分娩的初产妇100例进行对比。分别观察镇痛效果、产程进展、分娩方式、新生儿窒息、产后出血情况。结果笑气吸入和硬膜外阻滞镇痛的镇痛有效率分别是83.3%和97.3%;笑气组活跃期为(2.45±1.39)h,与硬膜外组(2.89±1.48)h及对照组(2.96±1.49)h相比,差异有统计学意义(P<0.05);笑气组第二产程为(0.69±0.42)h,与硬膜外组(0.84±0.48)h及对照组(0.87±0.46)h相比,差异有统计学意义(P<0.05);3组阴道助产率分别为4.2%、3.0%、4.7%,剖宫产率分别为28.3%、32.0%、29.3%,差异无统计学意义(P>0.05)。3组新生儿窒息率分别为0.6%、0.8%、0.0,差异无统计学意义(P>0.05)。3组产后出血率分别为1.7%、2.0%、2.0%,差异无统计学意义(P>0.05)。结论笑气吸入和硬膜外阻滞用于分娩镇痛安全有效,对母婴均无不良影响。笑气吸入可缩短产程,方便、易行、无创伤,更适于基层医院使用。
Objective To investigate the analgesic effects of niacin (inhalation nitrous oxide) inhalation and epidural blockade on labor analgesia and their effects on mother and infant. Methods From January to October 2003, a single fetus, head position and full-term primipara were hospitalized in Nanshan Maternal and Child Health Hospital of Shenzhen City. 120 cases of analgesia were smoothed with nitrous oxide. Low-dose ropivacaine plus fentanyl Epidural analgesia in 150 cases, and with the same period did not use analgesics single child, head, full-term delivery of primipara 100 cases were compared. Respectively observe the analgesic effect, labor progress, mode of delivery, neonatal asphyxia, postpartum hemorrhage. Results The effective rates of analgesia induced by inhaled nitrous oxide and epidural analgesia were 83.3% and 97.3% respectively. The active period of laughing gas group was (2.45 ± 1.39) h, which was significantly higher than that of epidural group (2.89 ± 1.48) h and (2.96 ± 1.49) h, the difference was statistically significant (P <0.05); The second stage of labor was (0.69 ± 0.42) h in the noxious group, which was significantly higher than that in the epidural group (0.84 ± 0.48) h and the control group (0.87 ± 0.46) h, the difference was statistically significant (P <0.05). The 3 groups of vaginal delivery rate were 4.2%, 3.0% and 4.7% respectively. The cesarean section rates were 28.3%, 32.0% and 29.3 %, The difference was not statistically significant (P> 0.05). The three groups of neonatal asphyxia rates were 0.6%, 0.8%, 0.0, the difference was not statistically significant (P> 0.05). The postpartum hemorrhage rates in the three groups were 1.7%, 2.0% and 2.0%, respectively, with no significant difference (P> 0.05). Conclusions Noxious inhalation and epidural blockade are safe and effective for labor analgesia and have no adverse effects on both mother and child. Smoky breathing can shorten the labor process, convenient, easy, non-invasive, more suitable for primary hospital use.