四川肛肠医院可靠 四大准则展现专业品质

来源:中外医学研究 ·2021年04月12日 08:12 浏览量:2056

沈熠 曹志方 林艺勇

 

 

【摘要】 意图:剖析聯合麻醉临产镇痛对正常产妇临产办法及产程的影响。办法:回归性剖析笔者地点医院2014年8月-2016年10月收治的1134例正常产妇的临床材料,依据是否选用临产镇痛分为对照组(n=497)和调查组(n=637)。对照组产妇未选用任何临产镇痛办法,调查组患者则选用联合麻醉临产镇痛。比照两组产妇阴道安产、产钳助产、剖宫产的构成等到缩宫素的运用率;别离记载比较两组产妇胎儿困顿、活泼期延伸、第二产程延伸、产后出血及新生儿窒息等状况;并将两组产妇各产程时刻与总产程时刻进行比较。成果:调查组产妇产钳助产率较高,剖宫产率较低,且缩宫素运用率较高,与对照组患者比较,差异有统计学含义(P<0.05);两组产妇阴道安产率比较差异无统计学含义(P>0.05)。调查组产妇胎儿困顿、活泼期延伸、第二产程延伸的发作率均比对照组高,差异均有统计学含义(P<0.05);但两组产妇产后出血及新生儿窒息发作率均较低,差异无统计学含义(P>0.05);调查组产妇榜首产程、第二产程及总产程时刻均善于对照组,差异均有统计学含义(P<0.05);两组产妇第三产程时刻比较差异无统计学含义(P>0.05)。定论:联合麻醉临产镇痛不能进步阴道安产率,而且缩宫素运用率较高,还会添加胎儿困顿、活泼期延伸及第二产程延伸的发作率,且榜首产程、第二产程及总产程时刻较长,因而对正常产妇需合理挑选运用联合麻醉进行临产镇痛。

【关键词】 联合麻醉; 镇痛; 临产办法; 产程

doi:10.14033/j.cnki.cfmr.2017.22.012 文章编号 B 文章编号 1674-6805(2017)22-0025-02

Analysis of the Effect of Combined Labor Analgesia on Delivery Mode and Delivery of Normal Pregnant Women/SHEN Yi,CAO Zhi-fang,LIN Yi-yong.//Chinese and Foreign Medical Research,2017,15(22):25-26

【Abstract】 Objective:To analyze the effect of combined labor analgesia on the delivery mode and labor process of normal pregnant women.Method:1134 cases of normal maternal clinical data of the authors hospital in August 2014 to October 2016 were analyzed,according to whether to use labor analgesia was divided into control group(n=497) and observation group(n=637).The control group wasn,t given labor analgesia,while the observation group was treated with combined anesthesia.The maternal vaginal delivery rate,forceps delivery rate,cesarean section rate and utilization rate of contractions of two groups were compared.The maternal fetal distress,prolonged active phase,prolonged second stage of labor,postpartum hemorrhage and neonatal asphyxia of two groups were compared.The labor time and total labor time of two groups were compared.Result:The maternal forceps delivery rate and cesarean section rate of the observation group was lower,and the use of oxytocin was higher compared with the control group,the differences were statistically significant(P<0.05).There was no statistically significant difference of maternal vaginal birth rate in the two groups(P>0.05).The maternal fetal distress,prolonged active phase,prolonged second stage of incidence of the observation group were higher than those in control group,the differences were statistically significant(P<0.05).The postpartum hemorrhage and neonatal asphyxia were lower of two groups,but there was no statistically significant difference(P>0.05).The first stage of the labor,the second stage of the labor and total labor time of the observation group were significantly higher than those of the control group,the differences were statistically significant(P<0.05).There was no statistically significant difference of the third stage of labor time between the two groups(P>0.05).Conclusion:Combined anesthesia can improve the analgesic delivery of the vaginal delivery rate,and the use of oxytocin will increase the higher rate of fetal distress,prolonged active phase and prolonged second stage of incidence,and the first stage the second stage of labor and the total labor time is longer,so the normal production and reasonable use of combined anesthesia labor analgesia.endprint

【Key words】 Combined anesthesia; Analgesia; Delivery mode; Labor process

First-authors address:The First Affiliated Hospital of Fujian Medical University,Longyan 364000,China

跟着人们生活水平的进步,患者对临床医治提出了更高要求,加之现阶段我国医疗水平不断进步,使得产妇关于临产镇痛的需求量不断上升[1]。临产镇痛虽能有用缓解产妇临产过程中的剧烈痛苦[2],但安全性还有待验证。为此,本文对笔者地点医院临产的1134例正常产妇的临床材料进行回忆性剖析,剖析联合麻醉临产镇痛对正常产妇临产办法及产程的影响。现陈述如下。

1 材料与办法

1.1 一般材料

回归性剖析笔者地点医院2014年8月-2016年10月收治的1134例正常产妇的临床材料,依据是否选用临产镇痛分为对照组(n=497)和调查组(n=637)。对照组产妇年纪19~36岁,

均匀(28.3±4.5)岁;初产产妇335例,经产产妇162例;孕周39~43周,均匀(40.6±1.1)周;体重55.4~76.9 kg,均匀

(63.4±5.2)kg。调查组产妇年纪20~36岁,均匀(28.5±4.4)岁;初产产妇465例,经产产妇172例;孕周38~43周,均匀(40.3±1.2)周;体重55.7~76.1 kg,均匀(63.0±5.3)kg。两组产妇一般材料比较差异无统计学含义(P>0.05)。

1.2 办法

对照组产妇临产过程中无任何临产镇痛办法;调查组患者则选用联合麻醉临产镇痛,于子宫口开到2~3 cm时行腰椎2~3空隙穿刺,达蛛网膜下腔后注入芬太尼0.01 mg,然后硬膜外腔头向置管3~5 cm用0.9%生理盐水100 ml+0.75%罗哌卡因10 ml+芬太尼0.1 mg混合液参加硬膜外镇痛泵内接于硬膜外导管,按6~8 ml/h泵入。

1.3 觀察目标

别离记载两组产妇阴道安产、产钳助产、剖宫产、缩宫素、胎儿困顿、活泼期延伸、第二产程延伸、产后出血及新生儿窒息等状况;并将两组产妇各产程时刻与总产程时刻进行比较。

1.4 统计学处理

选用SPSS 19.0软件对所得数据进行统计剖析,计量材料以(x±s)表明,选用t查验;计数材料以率(%)表明,选用字2查验,P<0.05为差异有统计学含义。

2 成果

2.1 两组产妇临产办法及缩宫素运用状况比较

两组产妇阴道安产率比较差异无统计学含义(P>0.05);但调查组产妇剖宫产率更低,产钳助产率与缩宫素运用率更高,与对照组产妇比较,差异有统计学含义(P<0.05),见表1。

2.2 两组产妇产程时刻及不良事情发作状况比比较

调查组产妇胎儿困顿、活泼期延伸、第二产程延伸发作率均比对照组高,差异均有统计学含义(P<0.05);但两组产妇产后出血及新生儿窒息发作比较差异无统计学含义(P>0.05),见表2。

2.3 两组产妇各产程时刻与总产程时刻比较

调查组产妇榜首产程、第二产程及总产程时刻均显着善于对照组,差异均有统计学含义(P<0.05);两组产妇第三产程时刻比较差异无统计学含义(P>0.05),见表3。

3 评论

上个世纪70年代,硬膜外麻醉临产镇痛在美国妇产科开端运用,至此,关于它对临产办法的影响备受重视[3]。由于我国没有遍及硬膜外麻醉临产镇痛,因而关于其报导较少,临床运用是否会对临产办法及产程形成影响也有待进一步研讨[4]。

本文研讨成果表明,调查组产妇产钳助产率、剖宫产率、缩宫素运用率、胎儿困顿率、活泼期延伸率及第二产程延伸率与对照组比较差异均有统计学含义(P<0.05),但两组产妇阴道安产率、产后出血率及新生儿窒息率比较差异无统计学含义(P>0.05);且调查组产妇榜首产程、第二产程及总产程时刻比对照组长,差异有统计学含义(P<0.05)。阐明选用联合麻醉临产镇痛可下降剖宫产率,由于目前我国剖宫产率快速上升的一个首要因素就是惊骇临产痛苦[5-6],选用联合麻醉临产镇痛后,产妇的心理障碍得以消除,因而剖宫产率便随之下降[7-8];但选用联合麻醉临产镇痛,会添加产钳助产率,因而阴道安产率并不会添加。此外,产妇临产期的痛苦首要在于榜首产程,痛苦会导致产妇过度焦虑、严重、惧怕[9],从而使交感神经振奋,儿茶酚胺类物质开释添加,导致宫缩按捺和子宫血管缩短[10],相应的便会添加缩宫素的运用率,一起还会使胎儿困顿、活泼期延伸、第二产程延伸的发作率添加[11]。

综上所述,联合麻醉临产镇痛不能进步阴道安产率,且会添加榜首产程、第二产程及总产程时刻较长,因而临床需合理运用。

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(收稿日期:2017-04-17)endprint

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