2100例椎管内阻滞分娩镇痛临床研究【中图分类号】R614【文献标识码】B【文章编号】1672-6383(2010)11-0001-03【摘要】目的：对2100例分娩镇痛临床资料进行回顾和分析，探讨椎管内阻滞分娩镇痛的临床应用价值。方法：596例硬膜外阻滞分娩镇痛,1540例腰-硬联合阻滞分娩镇痛。观察孕妇无创血压、心率、呼吸、脉搏血氧饱和度、宫腔压力、胎儿心率、视觉模拟评分(VAS)、改良Bromage评分、产程时间、出血量、新生儿评分、分娩方式、不良反应等。结果:腰-硬联合阻滞分娩镇痛组潜伏期缩短；0.125%布比卡因+2Pg/ml芬太尼硬膜外阻滞分娩镇痛组缩宫素使用率和剖宫产率比较高；蛛网膜下腔注射5卩g〜6Ug,硬膜外维持用0.143%甲磺酸罗哌卡因+0.3ug/ml舒芬太尼的腰-硬联合阻滞分娩镇痛组皮肤瘙痒率比较高。结论：椎管内阻滞分娩镇痛镇痛效果满意，不良反应少，对产妇和新生儿无不良影响。【关键词】分娩镇痛；蛛网膜下腔;硬膜外腔;舒芬太尼;布比卡因；罗哌卡因2100ZuZhiinsidetheZhuitubegivebirthtobabyatownpainclinicalanalysisQuanWeibinZhouChaomingLanChengyiPengLi【Abstract】Purpose：Therightnessis2100togivebirthtobabyatownpaintheclinicaldatacarryonreviewandanalysis,studyZhuitubeinsideZuZhigivebirthtobabytownpainofclinicalapplicationvalue.Method：596hardZuZhioutsidethefilmgivebirthtobabyatownpain,1540waist-hardconsociationZuZhigivebirthtobabytownpain.Observetionthepregnantwomandidn，tcreatebloodpressure,heartrate,breath,pulsebloodoxygensaturationdegree,templechamberpressure,embryo"sheartrate,senseofvisionimitategradepoint(VAS),improvementBromagegradepoint,producedistancetime,bleedquantity,newborn，sgradepoint,givebirthtobabyway,badreactionetc.・ResuIt:Waist-hardconsociationZutheZhigivebirthtobabyatownpainsettheincubationperiodshorten；0・125%C1othratiocardbecauseof+2aromaofug/mltootheNihardZuZhioutsidethefilmgivebirthtobabyatownpainsetSuotemplevegetableutilizationrateandPoutempleproducearatemoreGao；Thespider?swebfilmdescendachambertoinject5ugthe〜be6ugs,hardmaintenaneeoutsidethefilmuse0.143%AHuangsourMaocardbecauseof+0.3Pg/mlcomfortablearomatoothewaistofNi-hardconsociationZuZhigivebirthtobabytownpainsettheskinSaoYangratemoreGao.Conclusion：TheZuZhiintheZhuitubegivebirthtobabytownpaintownpaineffectsatisfaction,badreactionlittle,allgoodtothepregnantwomanandthenewborninfluence・[Keywords】Givebirthtobabyatownapain；Thespider?swebfilmdescendachamber；Hardchamberoutsidethefilm；ComfortablearomatooNi；Clothratiocardbecauseof；Maocardbecauseof总结我院自1998年至2010年2月临床资料记录完整的分娩镇痛2100例，现回顾分析如下。1.资料与方法1.1病例选择：年龄21岁〜35岁、身高150cm〜175cm、体重50Kg〜85Kg.妊娠周数38周〜41周、无椎管内麻醉禁忌症、无明显产科病理因素、ASAI〜II级,拟行阴道分娩的孕妇2100例。分娩镇痛前签署知情同意书。1.2镇痛方法。1.2.1596例采用硬膜外阻滞分娩镇痛，宫口开张3cm〜5cm行L2〜3或L3〜4间隙穿刺，向头端置入硬膜外导管3.5cm〜4.0cm,其中475例硬膜外腔用药为0.125%布比卡因+2Pg/ml芬太尼（A组）,121例硬膜外腔用药为0.1%罗哌卡因+0.2?g/ml舒芬太尼（B组）。负荷量5ml,维持量5ml〜7ml/h,PCA3ml〜4ml,锁定时间30min。宫口开全停用镇痛药。1.2.21540例采用腰-硬联合阻滞分娩镇痛，其中694例宫口开张1cm〜1.5cm行L2〜3或L3〜4硬腰穿刺，用针内针法，蛛网膜下腔注射2?g〜3?g舒芬太尼复合2mg〜3mg罗哌卡因（用0.9%氯化钠注射液稀释至1ml）,退出腰麻针后向头端置入硬膜外导管3.5cm〜4.0cm,硬膜外接镇痛泵,硬膜外腔用药为0.1%罗哌卡因+0.2?g/ml舒芬太尼。当孕妇VAS23分时开始持续硬膜外腔用药至第四产程（产后2h）停用镇痛药（C组）。810例宫口开张2cm〜5cm行L2〜3或L3〜4硬腰穿刺，用针内针法，蛛网膜下腔注射5ug~6iig舒芬太尼（用0.9%氯...