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目的腰麻复合硬膜外阻滞(CSEA)和笑气吸入无痛分娩的效果评估。方法90名足月初产孕妇随机分为实验组Ⅰ、实验组Ⅱ及对照组,前两组孕妇宫口开至3cm后,分别行CSEA及笑气吸入分娩镇痛,监测镇痛效果、产程各指标及测定β-内啡肽(β-EP)。结果实验组镇痛效果好于对照组,而实验组Ⅰ镇痛效果好于实验组Ⅱ。实验组Ⅰ活跃期短于对照组活跃期,实验组Ⅱ潜伏期后各产程均短于对照组。实验组Ⅰ与Ⅱ各产程无明显差异。宫缩强度、产钳率、剖宫产率、产后出血,胎儿窘迫、新生儿Apgar评分,三组无显著性差异。三组产妇β-EP浓度时均高于产后。产时β-EP实验组Ⅰ最低,实验组Ⅱ与对照组无差异;而产后β-EP实验组Ⅱ最高。结论CSEA及笑气吸入用于分娩镇痛,能缓解产痛,缩短产程,不影响产程中各因素。β-EP在分娩应激状态下升高,产后显著下降,提示β-EP参与分娩镇痛。
Objective To evaluate the effect of spinal anesthesia combined with epidural block (CSEA) and nitrous oxide inhalation on painless delivery. Methods Ninety pregnant women with full-term first trimester were randomly divided into experimental group I, experimental group II and control group. The first two groups were treated with CSEA and nitrous oxide respectively for labor analgesia and analgesic effect, Indicators and determination of β-endorphin (β-EP). Results The analgesic effect of the experimental group was better than that of the control group, while the analgesic effect of experimental group Ⅰ was better than that of experimental group Ⅱ. The active phase of experimental group Ⅰ was shorter than the active phase of the control group, while the average length of labor in experimental group Ⅱ was shorter than that of the control group. The experimental group Ⅰ and Ⅱ each birth process no significant difference. Contractility, forceps rate, cesarean section rate, postpartum hemorrhage, fetal distress, neonatal Apgar score, no significant difference between the three groups. Three groups of maternal β-EP concentrations were higher than postpartum. The β-EP group Ⅰ was the lowest during labor, there was no difference between the experimental group Ⅱ and the control group, while the β-EP group Ⅱ was the highest after delivery. Conclusions CSEA and nitrous oxide inhalation are used for labor analgesia, which can relieve labor pain, shorten the birth process and not affect various factors in the labor process. β-EP in labor stress increased, postpartum decreased significantly, suggesting that β-EP involved in labor analgesia.