硬膜外不同输注模式用于分娩镇痛的比较  

Comparison of different epidural infusion modes in labor analgesia

作　　者：张媛 刘志恒[3] ZHANG Yuan;LIU Zhiheng(Shantou University Medical College,Shantou 515041,China;Shenzhen Luohu District Maternaland Child Health Hospital,Shenzhen 518019,China;Department of Anesthesiology,Shenzhen Second People′s Hospital,Shenzhen 518038,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]深圳市罗湖区妇幼保健院麻醉科,广东深圳518019 [3]深圳市第二人民医院麻醉科,广东深圳518038

出　　处：《岭南现代临床外科》2019年第5期571-575,共5页Lingnan Modern Clinics in Surgery

摘　　要：目的比较规律间断硬膜外泵注(RIEB)和持续性硬膜外输注(CEI)复合病人自控硬膜外镇痛(PCEA)用于分娩镇痛的效果。方法自愿接受分娩镇痛的初产妇225例,按照随机数字表法分为A、B、C三组,每组75例。所有产妇给予硬膜外分娩镇痛,选取L2~3间隙行硬膜外穿刺,镇痛液配方为0.08%罗哌卡因+0.4μg/mL舒芬太尼。A组产妇予以CEI模式镇痛,8 mL/h持续输注镇痛液。B组与C组产妇予以RIEB模式镇痛,自注射首剂开始,每间断1 h给予8 mL镇痛液,其中B组的注射速度为2 mL/min,C组的注射速度为6 mL/min。记录产妇满意度评分,镇痛前(T1)、镇痛后30 min(T2)、1h(T3)、宫口开大7~8 cm时(T4)、宫口开全时(T5)、分娩时(T6)的平均动脉压(MAP)、心率(HR)、疼痛视觉模拟评分(VAS)和改良Bromage评分,观察病人自控硬膜外镇痛(PCEA)有效按压次数、罗哌卡因用量、舒芬太尼用量、产程、镇痛时间、分娩方式、新生儿Apgar评分、不良反应发生情况、产妇满意度评分。结果三组产妇T1~T3时点VAS评分无统计学差异(P>0.05);三组产妇T4~T6时点VAS评分,PCEA追加次数,罗哌卡因用量,舒芬太尼用量方面均显示C组B组>A组(P<0.05);三组患者的平均动脉压,心率,改良Bromage评分,产程,镇痛时间,分娩方式,不良反应发生率,新生儿Apgar评分无统计学差异(P>0.05)。结论 RIEB复合PCEA用于分娩镇痛的效果显著,且泵注速度为6 mL/min的效果最佳,可有效减少PCEA追加次数,罗哌卡因用量和舒芬太尼用量,提高产妇满意度,而不良反应并没有增加。Objective To compare the effects of regularintermittent epidural bolus(RIEB) and continuous epidural infusion(CEI)combined with patient-controlled epidural analgesia(PCEA)on labor analgesia. Methods 225 parturients who voluntarily received labor analgesia were randomly divided into three groups:A,B and C,75 cases in each. Epidural analgesia was used for all the paturients,through L2-3 intervertebral space with 0.08% ropivacaine and 0.4 μg/ml sufentanil as epidural analgesic solution. In group A,CEI mode of analgesia was applied with 8 ml/h continuous infusion of analgesic solution. In the other two groups,RIEB mode of analgesia were used and after the first dose,8 mL analgesic solution was injected epidural every one hour,on the speed of 2 ml/min in group B and 6 ml/min in group C respectively. Mean arterial pressure(MAP),heart rate(HR),the visual analogue scale(VAS),modified Bromage score were recorded at the following time points:before analgesia(T1),30 min after labor anesthesia(T2),60 min after labor anesthesia(T3),datively cervix to 7-8 cm(T4),full dilatation of cervix(T5),at labor(T6). Frequency of PCEA request,ropivacaine consumption,sufentanil consumption,total delivery duration,analgesic time,delivery mode,neonatal Apgar score,adverse reactions and parturients satisfaction score were observed. Results There was no significant difference in VAS score at T1,T2 and T3 among the three groups(P>0.05). The VAS score at T4,T5 and T6,frequency of PCEA request,ropivacaine consumption,sufentanil consumption group C<group B<group A,the difference was statistically significant(P<0.05). Maternal satisfaction score of Group C>Group B > Group A(P<0.05). There was no significant difference in MAP,HR,modified Bromage score,total delivery time,analgesic time,delivery mode,adverse reactions,neonatal Apgar score,adverse reactions among the three groups(P>0.05). Conclusion RIEB combined with PCEA is effective in labor analgesia,and the pump speed of 6 ml/min is the best,which effectively decrease the need of PCEA and the do

关 键 词：分娩镇痛 间断硬膜外泵注 持续性硬膜外输注 自控硬膜外镇痛 

分 类 号：R614[医药卫生—麻醉学]