单次背景输注和持续背景输注模式用于分娩镇痛的比较  

Comparison of automated mandatory bolus and continuous epidural infusion in parturient-controlled epidural analgesia during labor

作　　者：赵继蓉[1] 吴娟[1] 李胜华[1] 王霞红[2] 

机构地区：[1]上海市嘉定区妇幼保健院麻醉科,上海201821 [2]上海市嘉定区妇幼保健院产科,上海201821

出　　处：《上海医学》2013年第6期504-506,共3页Shanghai Medical Journal

基　　金：上海市嘉定区科学技术委员会科研基金资助项目(2010029)

摘　　要：目的比较单次背景输注(AMB)模式与持续背景输注(CEI)模式对产妇围产期状况及药物使用情况的影响。方法选取60例美国麻醉医师学会分级Ⅰ或Ⅱ级、孕38～42周、第1胎的产妇,在宫口开至2～3cm时采用蛛网膜下腔联合硬脊膜外腔阻滞行分娩镇痛,蛛网膜下腔注入罗哌卡因3mg。蛛网膜下腔阻滞后30min硬脊膜外腔给药,宫口开全后停用。镇痛液为0.5μg/mL舒芬太尼+1mg/mL罗哌卡因,根据给药模式随机分为AMB组和CEI组,每组30例。AMB组为每30min给药1次,3mL/次,给药速度为60mL/h;CEI组以6mL/h的速度持续给药。记录每小时罗哌卡因总量、需要患者自控硬脊膜外腔镇痛(PCEA)给药比例和首次使用PCEA距蛛网膜下腔阻滞的时间。观察两组产程、分娩方式、产后出血量、缩宫素使用情况、新生儿Apgar评分以及产妇的总体满意度。结果 AMB组每小时罗哌卡因总量为(8.5±1.3)mL/h,略少于CEI组的(9.1±2.1)mL/h。AMB组需要PCEA给药比例为17.2%(5/29),略低于CEI组的28.6%(8/28);AMB组首次使用PCEA距蛛网膜下腔阻滞的时间为(85.3±10.4)min,略长于CEI组的(71.8±13.4)min。AMB组的总体满意度为93.5±10.4,略高于CEI组的92.3±11.8。但两组间上述镇痛药物使用情况及总体满意度的差异均无统计学意义(P值均>0.05)。两组间各产程时间、分娩方式构成、产后出血量、缩宫素使用率及新生儿1和5minApgar评分的差异均无统计学意义(P值均>0.05)。结论与CEI模式比较,AMB模式的局部麻醉药用量相对较少,也是一种有效的分娩镇痛给药模式。Objective To compare the effect of automated mandatory bolus （AMB） with continuous epidural infusion （CED on maternal perinatal conditions and analgetic use. Methods Sixty primiparas, American Society of Anesthesiologists （ASA） grade Ⅰ or Ⅱ, 38 to 42 gestational weeks, were enrolled in the study. They were randomly divided into two groups （n = 30） and received subarachnoid anesthesia with 3 mg bupivacaine when the cervix was open to 2 -3 cm. Thirty minutes after that, epidural analgesia was conducted by background infusion plus primipara controlled epidural analgesia （PCEA） with 0.5 μg/mL sufentanil and 1 mg/mL ropivacaine. The pump was closed after whole cervix opened. The background infusion in AMB group delivered a 3 mL bolus at a rate of 60 mL/h per 30 min and in group CEI was a continuous infusion at 6 mL/h. Hourly ropivacaine consumption, proportion of PCEA request, duration from subarachnoid anesthesia to the first PCEA, total delivery time, delivery mode, postpartum hemorrhage, oxytocin usage, neonatal Apgar scores and overall satisfaction score were recorded. Results Hourly ropivacaine consumption was （8.5± 1.3） mL/h in AMB group and （9.1 ± 2.1） mL/h in CEI group. The proportion of PCEA request was 17.2% （5/29） in AMB group and 28.6% （8/28） in CEI group. The duration from subarachnoid anesthesia to the first PCEA was （85.3± 10.4） min in AMB group and （71.8 ± 13.4） min in CEI group. The overall satisfaction scores were 93.5 ± 10.4 in AMB group and and 92.3 ±11.8 in CEI group. There were no signficant differences in the above parameters between groups （all P〉0.05） neither were in delivery time, delivery mode, postpartum hemorrhage, oxytocin usage, or 1 min and 5 min Apgar scores （all P〉O. 05）. Conclusion Compared with CEI, AMB infusion can reduce the consumption of local anesthetic and is an effective labor analgetic method.

关 键 词：分娩镇痛 自动化单次背景输注 可行性 

分 类 号：R614[医药卫生—麻醉学]