程控间断硬膜外给药复合自控镇痛联合导乐分娩镇痛仪在初产妇分娩中的应用  

Application of the Programmed Intermittent Epidural Bolus Technique Added to Patient Controlled Analgesia Regimen in Conjunction with Doula Labor Analgesia Instrument in Primipara Delivery

作　　者：田春[1] 曾馨莹 陈有万 Tian Chun;Zeng Xinying;Chen Youwan(Department of Anesthesiology,Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;ICU,Chongqing Yongchuan District People's Hospital,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院麻醉科,重庆402160 [2]重庆市永川区人民医院ICU,重庆402160

出　　处：《医疗装备》2022年第1期5-10,共6页Medical Equipment

基　　金：重庆医科大学附属永川医院资助项目(YJLCX201623)。

摘　　要：目的评价程控间断硬膜外给药(PIEB)复合自控镇痛(PCA)联合导乐分娩镇痛仪在初产妇分娩中的应用效果。方法选取2018年9月至2020年11月在医院行阴道自然分娩并要求分娩镇痛的280名初产妇,按照纳入项目顺序编号,采用自愿结合数字表法随机将其分为PG1、PG2、P、G共4组,每组70名。PG1组(0.05%罗哌卡因+0.5μg/ml枸橼酸舒芬太尼)与PG2组(0.075%罗哌卡因+0.5μg/ml枸橼酸舒芬太尼)实施PIEB复合PCA联合导乐分娩镇痛仪分娩,P组(0.075%罗哌卡因+0.5μg/ml枸橼酸舒芬太尼)实施PIEB复合PCA分娩,G组实施导乐分娩镇痛仪分娩,比较4组分娩镇痛前即刻(T_(0))及镇痛后1(T_(1))、2(T_(2))、3(T_(3))、4(T_(4))、5 h(T_(5))和宫口开全时(T_(6))、产后1 h(T_(7))时的视觉模拟评分法(VAS)评分和分娩过程情况及产妇满意度。结果PG1、PG2、P组T_(3)、T_(4)、T_(5)、T_(6)、T_(7)时的VAS评分均低于G组,差异有统计学意义(P<0.05);PG1、PG2组T_(6)时的VAS评分均低于P组,差异有统计学意义(P<0.05)。PG1、G组产间发热发生率均低于PG2、P组,差异有统计学意义(P<0.05)。PG1、PG2、P组自然分娩率和产妇满意度均高于G组,且PG1组均高于P组,差异有统计学意义(P<0.05)。PG1、PG2组PCA按压次数均少于P组,且PG1组镇痛药物用药总量少于P组,差异有统计学意义(P<0.05)。结论PIEB复合PCA联合导乐分娩镇痛仪在初产妇分娩镇痛中的应用效果明显,可减轻分娩疼痛,减少镇痛药物用药总量和PCA按压次数,提升产妇自然分娩率和满意度,同时可通过降低硬膜外局部麻醉药物浓度,降低产间发热发生风险。Objective The application effects of the programmed intermittent epidural bolus(PIEB)technique added to patient controlled analgesia(PCA)regimen in conjunction with doula labor analgesia instrument in primipara delivery were investigated.Methods 280 full term nulliparous parturients who underwent vaginal delivery in the hospital from September 2018 to November 2020 and required labour analgesia were randomly divided into group PG1,PG2,P and G through volunteering combined with number table method according to the sequence of being included in this study.Each group had 70 subjects.Group PG1(0.05%ropivacaine with 0.5μg/ml sufentanil citrate)and group PG2(0.075%ropivacaine with 0.5μg/ml sufentanil citrate)delivered with PIEB combined with PCA and doula labor analgesia instrument.Group P(0.075%ropivacaine with 0.5μg/ml sufentanil citrate)delivered with PIEB combined with PCA.Group G delivered with doula labor analgesia instrument.The visual analogue scale(VAS)scores of the four groups were compared in different stages including immediately prior to labor analgesia(T_(0)),then hourly after anesthesia for five hours(T_(1),T_(2),T_(3),T_(4),T_(5)),when cervix fully open(T_(6)),and one hour after delivery(T_(7)).Besides,the delivery status and maternal satisfaction were also compared.Results The VAS scores of group PG1,PG2 and P were all lower than those of group G at T_(3),T_(4),T_(5),T_(6) and T_(7),with statistically significant differences(P<0.05);The VAS scores of group PG1 and PG2 were both lower than that of group P at T_(6),with statistically significant differences(P<0.05).The incidence of intrapartum fever in group PG1 and G were both lower than those in group PG2 and P,with statistically significant differences(P<0.05).The natural delivery rate and maternal satisfaction of group PG1,PG2 and P were higher than those in group G,and group PG1 was higher than group P,with statistically significant differences(P<0.05).The pressing frequency of PCA in group PG1 and group PG2 were less than that in group P,and the

关 键 词：分娩镇痛 程控间断硬膜外给药 硬膜外注射 导乐分娩镇痛 产间发热 

分 类 号：R714.3[医药卫生—妇产科学]