Jaschevatzky O E, Shalit A, Levy Y, Grünstein S
Br J Obstet Gynaecol. 1977 May;84(5):327-31. doi: 10.1111/j.1471-0528.1977.tb12592.x.
We report on the use of epidural analgesia during labour in 58 out of a total of 234 twin deliveries performed over a five-year period. A comparable control group consisted of 44 twin pregnancies delivered consecutively during the year preceding the introduction of epidural analgesia into our department. Epidural analgesia shortened the mean time of labour and made possible the performance of all necessary instrumental and obstetrical manoeuvres, without additional anaesthesia or adverse effects on the second twin. The epidural group required oxytocin more often due to an increased incidence of hypotonic uterine dysfunction. There was also a considerable increase of instrumental deliveries in the epidural group. The condition of the newborn infants of both groups, evaluated by Apgar score at one minute, was similar, but there was a higher perinatal mortality among pre-term infants delivered under epidural analgesia. Epidural analgesia was found to be an acceptable method of relieving pain in twin labour, but because of the increased necessity to use oxytocin and the relatively high perinatal mortality observed among pre-term infants, further experience is necessary before it can be claimed that this is the method of choice for relief of pain in twin labour.
我们报告了在五年期间进行的234例双胎分娩中，有58例在分娩时使用了硬膜外镇痛。一个可比的对照组由在我们科室引入硬膜外镇痛前一年连续分娩的44例双胎妊娠组成。硬膜外镇痛缩短了平均分娩时间，并使所有必要的器械助产和产科操作得以进行，且无需额外麻醉，对第二个胎儿也无不良影响。由于低张性子宫功能障碍发生率增加，硬膜外组更常需要使用缩宫素。硬膜外组器械助产率也显著增加。两组新生儿出生后1分钟时通过阿氏评分评估的状况相似，但在硬膜外镇痛下分娩的早产儿围产儿死亡率较高。硬膜外镇痛被认为是缓解双胎分娩疼痛的一种可接受方法，但由于使用缩宫素的必要性增加以及观察到早产儿中相对较高的围产儿死亡率，在声称这是双胎分娩疼痛缓解的首选方法之前，还需要进一步的经验。
