Vroman S, Yo Le Sian A, Thiery M, de Hemptinne D, Vanderheyden K, Van Kets H, Martens G, Derom R, Rolly G
Eur J Obstet Gynecol Reprod Biol. 1977;7(3):159-80. doi: 10.1016/0028-2243(77)90025-9.
Epidural analgesia (bupivacaine) was administered during labor after amniotomy, in some cases supplemented by intravenous oxytocin. A higher incidence of transient uterine hypertonus was seen after blocking. Fetal heart rate changes mainly took the form of bradycardia (in association with uterine hypertonus). At birth, the maternal biochemical condition was characterized by a lower degree of metabolic acidosis, compared to normal unanesthetized controls. The fetuses displayed a slight degree of hypoxia and hypercapnia. The mechanisms underlying these modifications are discussed. Epidural blockade in combination with elective induction of labor, whether or not supplemented by intravenous oxytocin, may carry a risk. Its magnitude is considered acceptable for both mother and fetus provided they are constantly under close surveillance, limited amounts of bupivacaine are administered and the second stage of labor is kept short. However, some warnings against epidural analgesia apply to patients with placental insufficiency and very active labor.
破膜后分娩期间给予硬膜外镇痛（布比卡因），部分病例辅以静脉滴注缩宫素。阻滞麻醉后短暂性子宫张力亢进的发生率较高。胎儿心率变化主要表现为心动过缓（与子宫张力亢进有关）。出生时，与未麻醉的正常对照组相比，产妇生化状况的特点是代谢性酸中毒程度较低。胎儿表现出轻度缺氧和高碳酸血症。文中讨论了这些改变的潜在机制。硬膜外阻滞联合选择性引产，无论是否辅以静脉滴注缩宫素，都可能存在风险。只要持续密切监测、使用有限剂量的布比卡因并缩短第二产程，其风险程度对母亲和胎儿来说都是可以接受的。然而，对于胎盘功能不全和产程非常活跃的患者，硬膜外镇痛需谨慎使用。
