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1、导乐分娩联合硬膜外镇痛效果评价【摘要】目的探讨导乐分娩联合硬膜外镇痛的效果和价值。方法选择60例待产妇随机分为A组(对照组,n=30,传统分娩+硬膜外镇痛)和B组(观察组,n=30,导乐分娩+硬膜外镇痛)。观察记录两组产程时间、疼痛的强度、分娩方式、阴道出血、胎儿宫内窘迫发生率、催产素使用率及新生儿Apgar评分。结果B组产程比A组缩短,镇痛效果优于A组(P0.05)。结论导乐分娩联合硬膜外麻醉镇痛效果更好,分娩中采取有效的全程陪伴护理措施,减轻产妇的紧张、焦虑情绪,明显缩短产程,减少剖宫产率和产后出血量。
2、�【关键词】硬膜外镇痛;导乐分娩;镇痛分娩��EfficacyevaluationofDoulachildbirthwithepiduralanalgesiaLIUXiao�fang.FengYu�feng.ObstetricalDepartment,XiamenMaternalandChildrenHospital,Xiamen361003,China�【Abstract】ObjectiveToinvestigatetheapplicationeffectsofDoula8childbirthwithep
3、iduralanalgesiaindeliveryrooms.MethodsSixtycaseswithsingle�fetusmaturepregnantwomenwererandomisedintotwogroupswith30caseseach.GroupA(controlgroup)receivedtraditionaldelivery+epiduralanalgesiaandgroupB(observationgroup)receivedDouladelivery+epiduralanalgesi
4、a.Thestagesoflabor,painintensity,deliverypattern,vaginalbleeding,incidencerateoffetalintrauterinedistress,userateofOxytocinandtheApgarscoreoffetusdeliveredwererecordedduringeachlaborwomen.ResultsThestagesoflaboringroupBwassignificantlyshorterthanthatingrou
5、pA(P0.05).ConclusionAnalgesiaeffectsofDoulachildbirthwithepiduralanalgesiaismuchbetter.Takingeffectivenursingmeasurewithwholeprocessaccompanyduringdeliverycanreducepregnantwomen’snervousemotionsandanxiety,shortensfetusdeliverytime,anddecreasetherateofcesar
6、eansectionandvaginalbleedingafterdelivery.省略1.1一般资料选择60例年龄20~33岁,身高157~172cm,体重59~738kg,孕38~41周,估计可行阴道分娩的孕妇,按随机数字表随机分为A组(n=30,传统分娩加硬膜外镇痛),B组(n=30,导乐分娩加硬膜外镇痛)。两组均为足月初产妇,单胎,枕先露;无骨软产道异常、头盆不称及产前出血等阴道分娩禁忌证,无严重的心肺肝肾功能异常、出凝血功能障碍及椎管穿刺禁忌证。�1.2方法孕妇感到明显腹痛时入产房,待宫口开大2~
7、3cm并且规律宫缩,上肢建立静脉置管以备输液,监测BP、HR和胎心。A组:麻醉医师在孕妇要求镇痛和家属签字同意后,选择L��3~4�或L��2~3�间隙行硬膜外穿刺,向头侧置入硬膜外导管,回吸导管无血、无脑脊液后注入0.75%罗派卡因10ml+芬太尼0.15mg+0.9%氯化钠注射液50ml混合液10ml,控制麻醉平面<T��8�,接一次性镇痛泵行患者自控硬膜外镇痛(Patient�ControlledEpiduralAnalgesia,PCEA),药袋中配备0.1%罗哌卡因100ml+芬太尼0.1mg,以
8、4~5ml/h速率泵入,宫口开全时关闭镇痛泵,待胎儿娩出后再将泵打开,直至产后2h,出产房前拔除硬膜外导管。若因产力因素出现产程进展延缓者,给予静脉滴注缩宫素1mU/min开始,15min调节一次滴数,直至宫缩为6~7次/15min到宫口开全9~10cm停止用药。B组:在A组的基础上,孕产妇在整个产程中由一位家属和一位经验丰富、责任心强的助产士一对一的导乐陪伴,给予产妇精神鼓励、心理护理,告知产程进展情况,指导产