程控硬膜外间歇脉冲注入与持续背景输注用于分娩镇痛的比较  

Clinical efficacy of programmed intermittent epidural bolus and continuous epidural infusion for labor analgesia

作　　者：方向东[1] 谢雷[1] 陈先侠[1] 

机构地区：[1]安徽省妇幼保健院(安徽医科大学妇幼保健临床学院)麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2016年第8期757-760,共4页Journal of Clinical Anesthesiology

基　　金：安徽省卫生计生委科研计划项目(14FR006)

摘　　要：目的比较程控硬膜外间歇脉冲注入（programmed intermittent epidural bolus,PIEB）和持续背景输注（CEI）两种模式联合PCEA用于分娩镇痛的临床效果。方法自愿接受分娩镇痛足月、单胎和头位初产妇200例,随机分为两组,每组100例。在宫口扩张2~3 cm时采用硬膜外阻滞行分娩镇痛。PIEB组背景输注剂量为8 ml/h,给药速度为6 ml/min,每小时给药一次;CEI组以8ml/h的速度持续给药。观察产妇镇痛前（T0）、镇痛后10 min（T1）、30 min（T2）、1 h（T3）、2 h（T4）、宫口开全时（T5）、分娩时（T6）、分娩后1 h（T7）BP、VAS评分、改良Bromage评分;PCEA追加次数、罗哌卡因、舒芬太尼的用量、宫缩情况、胎心率、产程时间、镇痛时间、分娩方式、产妇使用催产素、不良反应、新生儿Apgar评分、产妇满意度评分。结果 T4~T6时PIEB组VAS评分明显低于CEI组（P〈0.01）。PIEB组PCEA追加次数、药物用量明显少于CEI组（P〈0.05）,PIEB组产妇满意度明显高于CEI组（P〈0.05）。两组产妇的血压、宫缩持续时间和间隔时间、胎心率、产程、镇痛时间、分娩方式、使用催产素比例、不良反应发生率及新生儿Apgar评分差异无统计学意义。结论与采用CEI＋PCEA模式比较,PIEB＋PCEA模式的PCEA追加率更低、用药量更少、VAS评分更低、产妇的满意度更高,而不良反应并没有增加。Objective To compare the clinical efficacy of programmed intermittent epidural bollus（ PIEB） ＋ patient controlled epidural analgesia（ PCEA） and continuous epidural infusion（ CEI） ＋ PCEA for labor analgesia. Methods One hundred nulliparous parturients with cervical dilation of 2-3 cm were randomly assigned to PIEB group or CEI group for labor,with 100 parturients in each group. The background infusion in PIEB group delivered 8 ml bolus at a rate of 6 ml / min per 1 hour,in group CEI at 8 ml / h.Blood pressure,VAS score and modified Bromage score before labor anesthesia（ T0）,10 min after labor anesthesia（ T1）,30 min after labor anesthesia（ T2）,1 h after labor anesthesia（ T3）,2 h after labor anesthesia（ T4）,the uterus opening to the full extent（ T5）,childbirth（ T6）,1 h after childbirth（ T7）,proportion of PCEA request,hourly ropivacaine and sufentanil consumption,uterine contraction,fetal heart,total delivery time,analgesic time,delivery mode,number of cases using oxytocin,adverse reactions,neonatal Apgar score,maternal satisfaction score were observed. Results The VAS score of PIEB group was significantly lower than that of CEI group at T4-T6（ P〈0. 01）. Compared with the CEI group,protortion of PCEA request,the dosage of drug was decreased obviously in group PIEB（ P〈0. 05）,the maternal satisfaction of PIEB group was significantly higher than that of CEI group（ P〈0. 05）. There was no significant difference in the blood pressure,duration and interval time of uterine contraction,fetal heart,total delivery time,analgesic time,delivery mode,number of cases using oxytocin,adverse reactions,neonatal Apgar score and weight among two groups. Conclusion Compared with the CEI ＋ PCEA,the need of PCEA and the dosage of drug was decreased obviously,the VAS score was significantly lower,the maternal satisfaction was significantly higher and adverse reactions did not increase in the PIEB ＋ PCEA.

关 键 词：程控硬膜外间歇脉冲注入 硬膜外阻滞 分娩镇痛 

分 类 号：R714.3[医药卫生—妇产科学]