【摘要】 目的　探讨按产妇视觉模拟评分 (VAS评分 )给予分娩镇痛的可行性 ,明确产程早期给予硬膜外自控镇痛 (PCEA)对剖宫产率和产程的影响。方法　 176例初产妇 ,在其产程发动后VAS评分≥ 4分时 ,随机分为PCEA组 84例和对照组 92例 ,两组再按宫口的扩张程度分为≥ 4cm与 <4cm亚组。PCEA组硬膜外予 0 .1%布比卡因 (含芬太尼 2 μg/ml)首剂量为 8ml,背景量为 4ml,自控镇痛剂量为 4ml,锁定时间为 15min ,每小时最大剂量为 2 0ml。对照组给予全程助产士陪护及关怀。结果　两组宫口≥ 4cm和 <4cm亚组的第一产程、第三产程和活跃期时间的差异均无显著性 (P >0 .0 5 ) ,两组宫口 <4cm亚组第二产程时间的差异亦无显著性 (P >0 .0 5 ) ,但PCEA组宫口≥ 4cm亚组的第二产程时间长于对照组宫口≥ 4cm亚组 (P <0 .0 1)。两组宫口≥ 4cm和宫口 <4cm亚组剖宫产率的差异无显著性 (P >0 .0 5 )。但宫口 <4cm产妇的总剖宫产率显著高于宫口≥ 4cm(P <0 .0 1)。结论　按产妇VAS评分给予PCEA分娩镇痛是可行的 ,即使给予镇痛时子宫颈口 <4cm ,也不会延长产程及增加剖宫产率更多还原

【Abstract】 Objective To determine whether cervical dilatation during placement of epidural catheter for labor analgesia affects cesarean section rates or duration of labors. A prospective randomized controlled trial was conducted to investigate the efficacy of PCEA for labor analgesia based on VAS scores.Methods One hundred and seventy-six ASA 1～2 parturients were randomly assigned to PCEA group (n=84) and control group (n=92) when their VAS pain scores were ≥4 cm. In PCEA group, the parturients received bupivacaine 0.1% with fentanyl 2 mag/ml. The PCEA setting was 8 ml for loading dose; 4 ml/h for background dose; 4 ml for PCA-demand dose; 15 min lockout interval and maximum dose per hour was 20 ml. In the control group, parturients received continuous midwife care.Results The duration of first labour, third labour and activity duration were similar in either group with cervical dilatation <4 cm (n=43) or ≥4 cm (n=133) when epidural labor analgesia started. The duration of second labour was similar in both groups when cervical dilatation was less than 4 cm (P>0.05), but when the cervical dilatation was more than or equal to 4 cm during beginning of PCEA, the duration of second labour was longer in the PCEA group compared with that of the control group (98.1±15.8 vs 69.3±17.9, P<0.01). There was no significant difference in the cesarean section rates based on cervical dilatation <4 cm or ≥4 cm when epidural labor analgesia started (P>05), but the overall cesarean section rates was significantly higher when cervical dilatation was <4 cm as compared with ≥4 cm during starting of PCEA (P<0.01).Conclusion It is reasonable to start PCEA labor analgesia according to VAS scores, neither prolonged labor duration nor increased caesarean section rates are found even if the cervical dilatation is less than 4 cm when epidural labor analgesia starts.更多还原