本文選題：硬脊膜外隙　切入點(diǎn)：分娩鎮(zhèn)痛　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景 高剖宮產(chǎn)率是目前國內(nèi)產(chǎn)科面臨的現(xiàn)狀,如何降低剖宮產(chǎn)率則是產(chǎn)科臨床研究熱點(diǎn)。產(chǎn)婦或家屬主動(dòng)選擇剖宮產(chǎn)是目前國內(nèi)剖宮產(chǎn)率居高不下的重要原因之一,其中懼怕分娩疼痛是一個(gè)不可忽視的重要因素。尋求一種鎮(zhèn)痛效果確切、對(duì)母嬰影響輕微的分娩鎮(zhèn)痛方法,某種意義上,可能成為降低剖宮產(chǎn)率的重要舉措。 目的 探討硬脊膜外隙鎮(zhèn)痛對(duì)經(jīng)陰道分娩母嬰的安全性和有效性,為臨床大范圍開展分娩鎮(zhèn)痛提供參考依據(jù)。方法 選取2012年6月-2013年5月間、非合并其它系統(tǒng)疾病及產(chǎn)科合并癥、擬經(jīng)陰道分娩足月臨產(chǎn)孕婦60例,隨機(jī)分為硬膜外隙鎮(zhèn)痛(EA)組和非鎮(zhèn)痛(NA)組各30例。EA組：孕婦出現(xiàn)臨產(chǎn)先兆后進(jìn)入待產(chǎn)室,丌放一側(cè)上肢靜脈,恒速輸注0.9%氯化鈉200-300ml。記錄NBP、HR、SpO2做為基礎(chǔ)值。向孕婦詳細(xì)告知鎮(zhèn)痛泵使用方法及注意事項(xiàng)。左側(cè)臥,常規(guī)消毒鋪巾,于L2-3行硬膜外隙穿刺,置入硬膜外導(dǎo)管,妥善固定導(dǎo)管后改平臥,給予試驗(yàn)劑量1%利多卡因5ml,5分鐘后,針刺測(cè)痛,排除脊麻并確認(rèn)出現(xiàn)節(jié)段性阻滯平面。硬膜外隙注入首次鎮(zhèn)痛液劑量10ml(0.1%羅哌卡因+5μg舒芬太尼)后,接鎮(zhèn)痛泵。背景劑量6ml/h(身高160cm者)或8ml/h(身高≥160cm者),追加劑量3ml/次,鎖定時(shí)間15分鐘。首次注藥后半小時(shí),再次記錄NBP、HP、SpO2,并對(duì)孕婦進(jìn)行Bromage評(píng)分,記錄分值。NA組入待產(chǎn)室后,僅輸注0.9%氯化鈉200-300ml。監(jiān)測(cè)、記錄等同EA組。兩組于胎兒娩出即刻,采集臍靜脈血作血?dú)夥治�。新生兒出生�?min、5min、10min,由助產(chǎn)士、產(chǎn)科醫(yī)師和麻醉醫(yī)師分別獨(dú)立對(duì)新生兒行Apgar評(píng)分,取三者評(píng)分均值作為即時(shí)分值,記錄備統(tǒng)計(jì)分析。記錄各產(chǎn)程時(shí)間,產(chǎn)程中有否導(dǎo)尿,有否使用縮宮素,宮口擴(kuò)張至6-7cm時(shí)VAS評(píng)分,是否行會(huì)陰側(cè)切,產(chǎn)后2小時(shí)出血量,初乳始動(dòng)時(shí)間。新生兒神經(jīng)行為評(píng)分：新生兒生后72小時(shí),由兒科保健人員對(duì)新生兒進(jìn)行神經(jīng)行為評(píng)分并記錄。產(chǎn)程中產(chǎn)科醫(yī)師、麻醉醫(yī)師每隔2小時(shí)定期巡視,分別負(fù)責(zé)處理產(chǎn)科及分娩鎮(zhèn)痛中的突發(fā)事件與異常情況,保證產(chǎn)婦及胎兒安全、平穩(wěn)度過生產(chǎn)過程。 結(jié)果 EA與NA兩組孕婦一般資料無差別。EA組第一產(chǎn)程和第二產(chǎn)程較NA組延長(zhǎng)(P均0.001)；縮宮素使用率高于NA組(9vs.2,P0.05)；導(dǎo)尿率高于NA組(16vs.4,P0.01)；產(chǎn)后出血率(4vs.0)及陰道側(cè)切率(13vs.11)兩組無統(tǒng)計(jì)學(xué)差異(P均0.05)。EA組VAS評(píng)分明顯低于NA組(P0.001)；兩組Bromage評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組產(chǎn)婦泌乳始動(dòng)時(shí)間無統(tǒng)計(jì)學(xué)意義(34.1+1.4vs.37.6±1.3,P0.05)。EA組新生兒生后lmin/5min Apgar評(píng)分9.2±0.7/9.2±0.6雖略低于NA組9.6±0.5/9.6+0.5(P0.01),但無實(shí)際臨床意義,且生后10min兩組Apgar評(píng)分均達(dá)到10分。臍靜脈血?dú)夥治觯撼鼸A組pH值低于NA組(7.241±0.077vs.7.282±0.058,P0.05)外,其余各參數(shù)兩組間均無差別(P均0.05)。 結(jié)論 1.本研究所采用硬膜外隙分娩鎮(zhèn)痛方法效果確切,不影響產(chǎn)后泌乳過程,不增加產(chǎn)后出血,不影響產(chǎn)婦下肢活動(dòng),對(duì)經(jīng)陰道分娩產(chǎn)婦無不良影響。 2.本研究所采用硬膜外隙分娩鎮(zhèn)痛未見有實(shí)際臨床意義的新生兒不良影響,對(duì)新生兒安全,值得推廣
[Abstract]:Research background
The high rate of cesarean section is present obstetric face, how to reduce the rate of cesarean section is the obstetric clinical research focus. Maternal or families take the initiative to choose cesarean section is one of the important reasons for the high rate of cesarean section, the fear of labor pain is an important factor that can not be ignored. To seek a exact analgesic effect the effect of maternal childbirth analgesia method, mild, in a sense, may become an important measure to reduce the rate of cesarean section.
objective
To explore the safety and effectiveness of epidural space analgesia for vaginal delivery of mother and baby, and to provide a reference basis for a wide range of clinical labor analgesia.
From June 2012 -2013 year in May, with other system diseases and obstetric complications, 60 cases with vaginal delivery to full-term pregnant women, were randomly divided into epidural analgesia (EA) group and non analgesia (NA) group with 30 cases in each group:.EA pregnant women birth aura after entering the labour room, open side vein of upper limb and the constant infusion of 0.9% sodium chloride HR, 200-300ml. record NBP, SpO2 as the basic value. To inform pregnant women with analgesia methods and precautions. Lying on the left side, conventional disinfection shop towels on the L2-3 line, epidural puncture, epidural catheter was properly fixed catheter after supine, giving test dose 1% lidocaine 5ml, 5 minutes after acupuncture measuring pain, eliminate spinal anesthesia and confirm the segmental block. Epidural injection first analgesic liquid dose 10ml (0.1% ropivacaine +5 g sufentanil), analgesia pump. 6ml /h background dose (height 160cm) or 8ml/h (body More than or equal to 160cm), an additional dose of 3ml/ times, the locking time is 15 minutes. The first injection after half an hour, again to record NBP, HP, SpO2, and Bromage score of pregnant women, the scores of group.NA after entering the labour room, only infusion of 0.9% sodium chloride 200-300ml. monitoring, recording two groups of identical EA group. The delivery of the fetus immediately, the blood gas analysis of umbilical venous blood collection. After the birth of 1min, 5min, 10min, by midwives, obstetricians and anaesthetists were independent of neonatal Apgar score, the three is taken as the mean score of instant scores, records by statistical analysis. Records of the labor time, whether the catheter in the stage of labor, whether the use of oxytocin, cervical dilatation and 6-7cm VAS score, whether line episiotomy, amount of bleeding within 2 hours, the initial time of colostrum. Neonatal behavioral neurological assessment: 72 hours after birth of newborn, neonatal behavioral neurological assessment and recorded by pediatric care providers In the process of production. Obstetrician, every 2 hours for anesthesiologists regular inspections are responsible for handling emergencies and obstetric analgesia during childbirth and abnormal situation, ensure maternal and fetal safety, through the production process smoothly.
Result
EA and NA data of two groups of pregnant women in group.EA had no difference between the first stage and second stage of labor longer than that of group NA (P 0.001); use of oxytocin was higher than that of group NA (9vs.2, P0.05); the rate of catheterization was higher than that of group NA (16vs.4, P0.01); the rate of postpartum hemorrhage (4vs.0) and vaginal lateral incision rate (13vs.11) no significant difference between two groups (P 0.05).EA group VAS score was significantly lower in group NA (P0.001); the Bromage scores of the two groups had no statistical difference (P0.05). The two groups had no statistically significant maternal lactation initiating time (34.1+1.4vs.37.6 + 1.3, P0.05).EA groups after birth lmin/5min Apgar score 9.2 + 0.7/9.2 + 0.6 was slightly lower than that of group NA 9.6 + 0.5/9.6+0.5 (P0.01), but no actual clinical significance, 10min Apgar scores of the two groups reached 10 and students. After analysis of umbilical venous blood gas: pH in EA group was lower than that of NA group (7.241 + 0.077vs.7.282 + 0.058, P0.05), the rest of the parameters among the two groups no difference (P 0.05).
conclusion
1., epidural labor analgesia is effective in this study. It does not affect postpartum lactation process, does not increase postpartum hemorrhage, does not affect maternal lower limb activity, and has no adverse effect on vaginal delivery.
2. the use of epidural space labor analgesia in this research institute does not have the actual clinical significance of neonatal adverse effects. It is worth popularizing for the safety of the newborn.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.3

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