目的 研究腰麻联合硬膜外麻醉和硬膜外麻醉这两种镇痛方式对子宫收缩节律性的影响.方法 随机选取湖南省妇幼保健医院2014年1月2016年10月300例分娩产妇,随机分为实验组150例和对照组150例,在分娩过程中实验组行腰麻联合硬膜外麻醉,对照组行硬膜外麻醉,并互相比较两种镇痛方法对子宫收缩时间和间隔时间的影响.结果 镇痛后实验组和对照组产妇对比使用缩宫素的量及镇痛起效时间、用药量、按压次数、Bromage评分、Apgar评分差异均无统计学意义(x2/t值分别为2.04、1.67、2.45、1.85、1.35,均P＞0.05);腰麻联合硬膜外麻醉比硬膜外麻醉更能延长患者子宫收缩的持续时间和间隔时长,且其药物起效时间也比硬膜外麻醉快很多(x2/t值分别为2.85、10.94,均P＜0.05);实验组产妇中有5例胎心早期减速,30例胎心晚期减速,对照组有6例胎心早期减速,28例胎心晚期减速,两组之间比较无显著性差异(x2/t值分别为3.65、4.97,均P＞0.05);据VAS评分显示,实验组和对照组都能减轻产妇的疼痛,且实验组比对照组更能减轻产妇的疼痛(t=6.98,P＜0.05).结论 腰麻联合硬膜外麻醉相对传统的硬膜外麻醉能更好的减轻孕分娩时的剧烈疼痛,且其对子宫收缩的持续时间和间隔时长更长,可达到缩短产时,减少剖宫产机率,提高顺产机率的目的.%Objective To study the effect of spinal epidural anesthesia and that of epidural anesthesia on uterine contraction rhythm.Methods Totally 300 puerpera during January 2014 to October 2016 in Maternal and Child Health Care Hospital of Hunan Province were selected randomly.They were randomly divided into experimental group (150 cases) and control group (150 cases).During the delivery,spinal anesthesia combined with epidural anesthesia was provided in the experimental group,while epidural anesthesia was given in the control group.The effects of two analgesic methods on uterine contraction time and interval were compared.Results There was no significant difference between two groups in amount of oxytocin,onset time,dosage,frequency,Bromage score and Apgar score (x2/t value was 2.04,1.67,2.45,1.85 and 1.35,respectively,all P ＞ 0.05).Compared to epidural anesthesia,spinal anesthesia combined with epidural anesthesia could prolong uterine contraction duration and the interval time,and the onset time of drugs was much faster than that of epidural anesthesia (x2/t value was 2.85 and 10.94,respectively,both P ＜ 0.05).In the experimental group,the number of fetal heart deceleration in early stage was 5 and the number of fetal heart deceleration in late stage was 30,while in the control group,the number of fetal heart deceleration in early stage was 6 and the number of fetal heart deceleration in late stage was 28.There was no significant difference between two groups (x2/t value was 3.65 and 4.97,respectively,both P ＞ 0.05).According to VAS score,the method for the experimental group and the control group could reduce maternal pain,and the experimental group had better effect than the control group in reducing maternal pain (t =6.98,P ＜ 0.05).Conclusion Compared to traditional epidural anesthesia,spinal anesthesia combined with epidural anesthesia could better reduce the severe pain during pregnancy with longer duration of uterine contraction and interval.It can shorten labor stage,reduce possibility of cesarean section and improve the probability of natural delivery.It should be strongly advocated in clinics.
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