硬脊膜穿破硬膜外阻滞与直接硬膜外阻滞在分娩镇痛中的应用比较  

Application comparison of dural penetrating epidural block and direct epidural block in labor analgesia

作　　者：晏明 张玉凤 李晓琼[2] 崔恩惠[1] 丁松 孙剑[1] YAN Ming;ZHANG Yufeng;LI Xiaoqiong;CUI Enhui;DING Song;SUN Jian(Department of Anesthesiology,Huai’an Maternal and Child Health Care Hospital,Jiangsu Province,Huai’an 223002,China;Department of Obstetrics and Gynecology,Huai’an Maternal and Child health Care Hospital,Jiangsu Province,Huai’an 223002,China)

机构地区：[1]江苏省淮安市妇幼保健院麻醉科,江苏淮安223002 [2]江苏省淮安市妇幼保健院产科,江苏淮安223002

出　　处：《中国医药导报》2020年第36期181-184,共4页China Medical Herald

基　　金：江苏省妇幼健康科研项目(F201857)。

摘　　要：目的比较硬脊膜穿破硬膜外阻滞与直接硬膜外阻滞在分娩镇痛中的应用效果。方法选取2019年1月—2020年1月江苏省淮安市妇幼保健院产科行阴道分娩要求分娩镇痛的112名产妇为研究对象,按随机数字表法分为A组和B组,每组56名。A组行直接硬膜外阻滞镇痛,B组行硬脊膜穿破硬膜外阻滞镇痛。监测两组各指标变化。结果两组产程、新生儿Apgar评分比较,差异无统计学意义(P>0.05)。镇痛前两组视觉模拟评分(VAS)比较,差异无统计学意义(P>0.05);镇痛后B组各时间点VAS评分低于A组,差异有统计学意义(P<0.05)。B组第一产程、第二产程、第三产程血清疼痛介质5-羟色胺、P物质、神经肽水平低于A组,差异有统计学意义(P<0.05)。B组镇痛良好率高于A组,差异有统计学意义(P<0.05)。两组不良事件发生率、分娩方式比较,差异无统计学意义(P>0.05)。B组分娩满意度高于A组,差异有统计学意义(P<0.05)。结论与直接硬膜外阻滞比较,硬脊膜穿破硬膜外阻滞在分娩镇痛中的应用价值相对理想。Objective To compare the application effect of dural penetrating epidural block and direct epidural block in labor analgesia.Methods From January 2019 to January 2020,112 parturients who need labor analgesia in Huai’an Maternal and Child Health Hospital of Jiangsu Province were selected as study objects.They were divided into group A and B according to random number table method,with 56 parturients in each group.Group A was received direct epidural block analgesia and group B was received dural penetrating epidural block analgesia.The changes of each index were monitored between two groups.Results There were no significant differences in labor stages and neonatal Apgar score between two groups(P>0.05).There was no significant difference in visual analogue scale(VAS)score between two groups before analgesia(P>0.05),after analgesia,VAS scores at each time point in group B were lower than those in group A,and the differences were statistically significant(P<0.05).The levels of serum pain mediators 5-hydroxy tryptamine,substance P and neuropeptide in the first,second and third labor stages in group B were lower than those in group A,with statistically significant differences(P<0.05).The rate of good analgesia in group B was higher than that in group A,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse events and delivery mode between two groups(P>0.05).The labor satisfaction of group B was higher than that of group A,and the difference was statistically significant(P<0.05).Conclusion Compared with direct epidural block,the application value of dural penetrating epidural block in labor analgesia is relatively ideal.

关 键 词：硬脊膜穿破硬膜外阻滞 直接硬膜外阻滞 分娩镇痛 

分 类 号：R714.3[医药卫生—妇产科学]