穴位注射曲马多联合静滴安定用于分娩镇痛及加速产程效果的研究

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[摘要] 目的 观察联合应用穴位注射曲马多和静滴安定对分娩镇痛及加速产程的效果。 方法 将180例可阴道试产的产妇随机分为A、B、C组，在常规产时服务模式的基础上，A组静滴安定和双侧足三里穴位注射曲马多，B组仅双侧足三里穴位各注射曲马多，C组不予施药。观察分析三组药物不良反应、镇痛效果、第一产程时长、分娩方式以及新生儿窒息率。 结果 用药组有轻微不良反应；A组镇痛有效率高于B组（P < 0.05）；C、B、A组第一产程时长依次降低（P < 0.05）；阴道分娩率A组高于B组和C组（P < 0.05），B组和C组相当（P > 0.05）；新生儿窒息率三组间差异无统计学意义（P > 0.05）。 结论 穴位注射曲马多联合静滴安定不但能减轻分娩疼痛，缩短产程时间，提高阴道分娩率，降低剖宫产率，而且简单安全，值得临床应用和推广。

[关键词] 分娩镇痛；穴位注射；曲马多；安定

[中图分类号] R714.3 [文献标识码] A [文章编号] 1673-7210（2012）07（a）-0084-02

The study of Tramadol by point injection combined with Diazepam by intravenous in labor analgesia and accelerating the parturient

LI Yanfang LI Xuelian CHEN Qian ZHANG Jinfeng LUO Yonghong

Xixiang People's Hospital of Bao′an District, Guangdong Province, Shenzhen 518000, China

[Abstract] Objective To evaluate the efficacy of Tramadol by point injection combined with Diazepam by intravenous in labor analgesia and accelerating the parturient. Methods 180 cases which could attempt vaginal labor were assigned randomly into three groups as follows: group A received intravenous injection of Diazepam and point injection of Tramadol at bilateral Zusanli; group B only received point injection of Tramadol at bilateral Zusanli; group C was treated with conventional therapy without administration of drugs mentioned above. Adverse drug reactions, the analgesic effect, time of the first stage of labor, mode of delivery, and the rate of neonatal asphyxia were analyzed. Results Group A and B had a mild adverse reactions. The analgesic in group A was higher than that of group B (P < 0.05). Time of the first stage of labor was decreased in sequence of group C, B and A (P < 0.05). The rate of vaginal delivery in group A was higher than that in group B and in group C (P < 0.05). The rate of neonatal asphyxia between three groups had no statistical differences (P > 0.05). Conclusion Tramadol by point injection combined with Diazepam by intravenous can not only alleviate labor pain, shorten labor time, and increase the rate of vaginal delivery to reduce the rate of cesarean section, but also has simple security property. which is worthy of clinical application.

[Key words] Labor Analgesia; Point Injection; Diazepam; Tramadol

近年来，导致剖宫产率不断攀升的一个重要原因是阴道分娩过程中让产妇紧张焦虑甚至恐惧的分娩疼痛[1]。寻求一种简单安全，既能缩短产程，又能保障母婴安全的分娩镇痛方法，一直是产科工作者努力的方向。近期我院开展了穴位注射曲马多联合静滴安定用于分娩镇痛及加速产程效果的应用研究，现报道如下：

1 资料与方法

1.1 一般资料

从2011年5月～12月来我院分娩的产妇中，选取孕37～41周、单活胎、头位、年龄22～35岁的初产妇，排除阴道分娩禁忌证和（或）严重内外科合并症者，共计180例，平均年龄（26.70±7.39）岁，孕（38.12±1.55）周。所有产妇均经由接诊医生进行常规产时模式和分娩镇痛模式的介绍，自主选择并签署知情同意书。将其随机分为A、B、C三组，A组（曲马多+安定组）、B组（曲马多组）和C组（对照组）各60例，组间经统计学检验，产妇年龄和孕周等差异无统计学意义（P > 0.05），具有可比性。