Hollmén A, Jouppila R, Pihlajaniemi R, Karvonen P, Sjöstedt E
Acta Anaesthesiol Scand. 1977;21(3):174-81. doi: 10.1111/j.1399-6576.1977.tb01207.x.
Segmental epidural analgesia (T10-T12) was performed in 418 parturients, using a 4-6 ml dose of 0.5% bupivacaine, with or without adrenaline. Seventy per cent of parturients were primiparas and 30% had histories, or signs, of possible uteroplacental insufficiency. Our aim was to relieve pain during the long passive opening phase, so that mothers would be rested and active at the beginning of the second phase, but also to avoid abolishing the bearing-down reflex, the absence of which causes an increased frequency of instrumental delivery. The analgesia during the opening phase was of good quality in 89% of primiparas, and 84% of multiparas. The onset of analgesia was rapid (3-5 min) and the duration was on average 2 1/2 h. The incidence of foetal heart rate changes, during the 30 min after epidural, was 5%. The second phase was less than 30 min in about 90% of cases. About 90% of parturients delivered spontaneously, and the frequency of instrument delivery was only 7.4%. Caesarean section was required in 3.7%. Slight, but rapidly correctable, hypotension occurred in 16.5%, and in two cases the hypotension led to more serious complications. This stresses the importance of the availability and competence of both the anaesthetic and obstetric teams. There were no maternal or neonatal mortalities, and the Apgar scores compared well with the figures for the normal material in our obstetric unit.
对418名产妇实施了节段性硬膜外镇痛（T10 - T12），使用0.5%布比卡因4 - 6毫升剂量，加或不加肾上腺素。70%的产妇为初产妇，30%有潜在子宫胎盘功能不全的病史或体征。我们的目的是在漫长的被动扩张期缓解疼痛，以便母亲在第二产程开始时能得到休息并保持体力，但同时要避免抑制屏气反射，因为缺乏该反射会导致器械助产频率增加。在扩张期，89%的初产妇和84%的经产妇镇痛效果良好。镇痛起效迅速（3 - 5分钟），平均持续时间为2.5小时。硬膜外麻醉后30分钟内胎儿心率变化的发生率为5%。约90%的病例第二产程持续时间不到30分钟。约90%的产妇自然分娩，器械助产频率仅为7.4%。剖宫产率为3.7%。16.5%的产妇出现轻度但可迅速纠正的低血压，有两例低血压导致了更严重的并发症。这凸显了麻醉团队和产科团队随时待命及具备专业能力的重要性。没有产妇或新生儿死亡，阿氏评分与我们产科病房正常产妇的评分相当。
