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目的 :观察硬膜外病人自控镇痛 (patientcontrolledepiduralanalgesia ,PCEA)用于分娩镇痛的效果及对产程和母婴的影响。方法 :选择无合并症孕妇 10 0例 ,随机分为无痛组和对照组各 5 0例。无痛组是在宫口扩张潜伏期末或活跃期自愿要求无痛分娩的产妇 ,取L3～ 4 间隙为穿刺点 ,首次用 0 .75 %利多卡因 5ml,连接PCA泵 ,内置溶液 60ml(0 .12 5 %布比卡因加芬太尼 1～ 2mg·L-1) ,第 1小时 <15ml,以后约 10ml·h-1,用药量 4～ 5 5ml,至宫口近全或开全时停药 ,观察镇痛效果、产程、分娩方式、产后出血量及胎儿新生儿情况。结果 :无痛组虽然子宫收缩有短时间的轻度抑制 ,但不影响产力 ,活跃期缩短 ,第二产程不用药可避免该产程延长。羊水污染、胎心异常及新生儿评分与对照组比无显著差异。结论 :PCEA用于分娩镇痛安全、有效 ,对母婴均无不良影响。
OBJECTIVE: To observe the effect of patient-controlled analgesia (PCEA) on labor analgesia and its effects on labor process and maternal and infant. Methods: One hundred and seventy pregnant women without complications were randomly divided into painless group and control group of 50 cases. The painless group was a woman who volunteered for painless childbirth at the end of the latent period or the active stage of cervical dilatation. Taking L3 ~ 4 gap as the puncture point and the first time using 0.75% lidocaine 5ml, connected with PCA pump, built-in solution 60ml (0 .12 5% bupivacaine plus fentanyl 1 ~ 2mg · L-1), the first hour <15ml, after about 10ml · h-1, the dose of 4 ~ 5 5ml to the cervix nearly all or open When withdrawal, observed analgesic effect, labor, delivery mode, postpartum hemorrhage and fetal neonatal conditions. Results: Although there was a slight inhibition of uterine contraction in a painless group for a short time, it did not affect the productivity and the active period was shortened. The second stage of labor without medication could avoid prolongation of the labor process. Amniotic fluid contamination, fetal heart rate abnormalities and neonatal score and control group no significant difference. Conclusion: PCEA is safe and effective for labor analgesia and has no adverse effect on mother and infant.