程序性间断硬膜外给药联合硬膜刺破硬膜外麻醉在分娩镇痛中的应用  

Programmed intermittent epidural bolus combined with dural puncture epidural anesthesia in labor analgesia

作　　者：许兰兰 陆红明 刘景菁 邹昌骝 XU Lanlan;LU Hongming;LIU Jingjing;ZOU Changliu(Department of Anesthesiology,the Third Affiliated Hospital of Shenzhen University,Shenzhen518005,China;Department of Anesthesiology,Xilin People′s Hospital in Guangxi Zhuang Autonomous Region,Xilin533500,China;Operating Room,the Third Affiliated Hospital of Shenzhen University,Shenzhen518005,China)

机构地区：[1]深圳大学第三附属医院麻醉科,广东深圳518005 [2]广西壮族自治区西林县人民医院麻醉科,广西西林533500 [3]深圳大学第三附属医院手术室,广东深圳518005

出　　处：《中国现代医生》2021年第30期128-131,135,共5页China Modern Doctor

摘　　要：目的探讨程序性简短硬膜外给药技术联合硬膜刺破硬膜外麻醉优化技术在产妇分娩镇痛中的安全性和有效性。方法选取2019年12月至2020年12月在深圳市罗湖人民医院和西林县人民医院进行分娩镇痛的产妇110例,采用随机数字表法分为程序性间断硬膜外给药组(P组,n=55)和对照组(C组,n=55),记录镇痛前,镇痛后10、30、60、90 min,第二产程VAS评分,产妇的心率及MAP、PCEA次数及产妇剖宫产率、器械助产率、Bromage评分、不良反应(胎心减速率、低血压、恶心呕吐、瘙痒、神经功能障碍)、新生儿1 min及5 min Apgar评分。结果P组在分娩镇痛后60 min、第二产程的MAP[(74.71±6.84)mmHg,(80.38±6.59)mmHg],第二产程VAS为(1.49±1.12)分、PECA为(3.76±2.21)次,均低于C组镇痛后60 min的第二产程MAP[(79.31±7.10)mmHg,(82.84±5.81)mmHg],第二产程VAS(1.49±1.12)分及PECA次数(5.29±3.20)次,两组比较,差异有统计学意义(P<0.05);两组分娩方式、不良反应及新生儿Apgar评分等比较,差异均无统计学意义(P>0.05)。结论PIEB联合DPE技术对产妇MAP的影响更大,并且能够提供更好的第二产程镇痛效果及更少的药物使用量,对产科结局、运动神经阻滞情况、不良反应及新生儿结局都未产生不良影响。Objective To explore the safety and effectiveness of programmed intermittent epidural bolus(PIEB)combined with optimized dural puncture epidural(DPE)anesthesia in maternal labor analgesia.Methods A total of 110 puerperae who underwent labor analgesia in Shenzhen Luohu People′s Hospital and Xilin People′s Hospital from December 2019 to December 2020 were selected.They were divided into the programmed intermittent epidural bolus group(group P,n=55)and the control group(group C,n=55)by using the random number table method.The scores of Visual Analogue Scale/Score(VAS),heart rate,mean arterial pressure(MAP),number of patient controlled epidural analgesia(PCEA)of puerperae before analgesia,and at 10 min,30 min,60 min and 90 min after analgesia as well as the second stage of labor were recorded.The cesarean section rate,instrument midwifery rate and Bromage score of puerperae,adverse reac tions[ARs(the deceleration rate of fetal heart,hypotension,nausea and vomiting,pruritus,neurological dysfunction)],and the Apgar score of the neonates at 1 min and 5 min after birth were also recorded.Results The MAP at 60 min after analgesia and the second stage of labor[(76.29±6.25)mmHg,80.32±6.59)mmHg],VAS score at the second stage of labor(1.49±1.12)points,and number of PECA(3.76±2.21)times in group P were all lower than those of group C[(79.31±7.10)mmHg,(82.84±5.81)mmHg],(1.49±1.12)points and(5.29±3.20)times,respectively],with statistically significant differences(P<0.05).There were no statistically significant differences between the two groups in mode of delivery,ARs and Apgar scores of the neonates(all P>0.05).Conclusion PIEB combined with DPE technique has a greater effect on MAP of puerperae and can provide better analgesia in the second stage of labor with less drug use.It has no adverse effects on obstetric outcomes,motor nerve block conditions,ARs and neonatal outcomes.

关 键 词：硬膜外麻醉 分娩镇痛 程序性间断硬膜外给药 硬脊膜穿破硬膜外麻醉 

分 类 号：R715.7[医药卫生—妇产科学]