硬脊膜穿破硬膜外阻滞与腰硬联合阻滞在初产妇分娩镇痛中的应用效果及对母婴安全的影响  

The application effect of dural puncture epidural and combined spinal and epidural in labor analgesia of primipara and its influence on the safety of mother and infant

作　　者：朱立杰 吕小静 闫战秋 崔秀荣 刘忠玉 Zhu Lijie;Lyu Xiaojing;Yan Zhanqiu;Cui Xiurong;Liu Zhongyu(Department of Anesthesiology,Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao Hebei 066000,P.R.China;Medical Insurance Price Section,Qinhuangdao Maternal and Child Health Hospital,,Qinhuangdao Hebei 066000,P.R.China)

机构地区：[1]秦皇岛市妇幼保健院麻醉科,河北秦皇岛066000 [2]秦皇岛市妇幼保健院医保物价科,河北秦皇岛066000

出　　处：《中国计划生育和妇产科》2021年第12期35-38,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：秦皇岛市科学技术研究与发展计划项目(项目编号:201902A213)。

摘　　要：目的探究硬脊膜穿破硬膜外阻滞(dural puncture epidural,DPE)与腰硬联合阻滞(combined spinal-epidural anesthesia,CSE)在初产妇分娩镇痛中的应用效果及对母婴安全的影响。方法选取2019年12月至2020年6月在秦皇岛市妇幼保健院进行分娩的150例健康初产妇为研究对象,按照随机数字表法分为两组,各75例。CSE组应用CSE镇痛,DPE组应用DPE镇痛。比较两组镇痛效果、产妇分娩情况及不良反应发生情况。结果CSE组镇痛起效时间短于DPE组(P<0.05)。镇痛给药前(T1)时刻,两组产妇疼痛视觉模拟(visual analogue scale,VAS)评分比较,差异无统计学意义(P>0.05);与T1时刻相比,两组产妇在镇痛给药10 min(T2)、镇痛给药30 min(T3)、镇痛给药60 min(T4)及宫口全开时(T5)等不同时刻VAS评分均显著降低(P<0.05);但DPE组在T2、T3、T4、T5时刻VAS评分与CSE组比较,差异均无统计学意义(P>0.05)。两组产妇第一产程时间、第二产程时间、第三产程时间、自然分娩率、新生儿1 min和5 min Apgar评分以及下肢运动阻滞评分各分娩指标比较,差异均无统计学意义(P>0.05)。DPE组皮肤瘙痒、胎心异常不良反应发生率(4.00%、1.33%)显著低于CSE组(21.33%、10.67%),差异有统计学意义(P<0.05)。结论DPE与CSE对初产妇分娩均能提供快速、有效的镇痛效果,但DPE不良反应少,安全性更高。Objective To explore the application effect of dural puncture epidural(DPE)and combined spinal and epidural(CSE)in labor analgesia of primipara and its influence on the safety of mother and infant.Methods A total of 150 healthy primiparas who delivered in Qinhuangdao Maternal and Child Health Hospital from December 2019 to June 2020 were selected as the research objects,and according to the different ways of analgesia during delivery,they were randomly divided into two groups:CSE group(75 cases)and DPE group(75 cases).CSE was used in CSE group and DPE in DPE group.The analgesic effect,parturient delivery and adverse reactions were observed and compared between the two groups.Results The onset time of analgesia in CSE group was shorter than that in DPE group(P<0.05).There was no significant difference in visnal analogue scale(VAS)score between the two groups before analgesic administration(T1)(P>0.05);Compared with the time of T1,the VAS score of the two groups were significantly lower at 10 min after analgesic administration(T2),30 min after analgesic administration(T3),60 min after analgesic administration(T4)and full opening of uterus(T5)(P<0.05);but there were no significant differences in VAS score between DPE group and CSE group at the same time(P>0.05).There were no significant differences between the two groups in the first stage of labor,the second stage of labor,the third stage of labor,the rate of natural delivery,the 1 min Apgar score,the 5 min Apgar score and the lower extremity motor block score(P>0.05).The incidences of skin pruritus and abnormal fetal heart rate in DPE group were 4.00%and 1.33%,which were significantly lower than 21.33%and 10.67%in CSE group(P<0.05).Conclusion Both DPE and CSE can provide rapid and effective analgesic effect for primipara,but the former should have fewer adverse events and higher safety.

关 键 词：硬脊膜穿破硬膜外阻滞 腰硬联合阻滞 初产妇分娩镇痛 应用效果 母婴安全 

分 类 号：R614[医药卫生—麻醉学] R714[医药卫生—外科学]