潜伏期硬膜外长间歇脉冲注射技术用于分娩镇痛的效果  

Efficacy of long-interval programmed intermittent epidural bolus during incubation period for labor analgesia

作　　者：郑岗 樊雅玲[1] 邓长流[2] 王进全 Zheng Gang;Fan Yaling;Deng Changliu;Wang Jinquan(Department of Anesthesiology,People′s Hospital of Leshan,Leshan 614000,China;Department of Anesthesiology,the Ninth People′s Hospital of Chongqing,Chongqing 400799,China)

机构地区：[1]四川省乐山市人民医院麻醉科,乐山614000 [2]重庆市第九人民医院麻醉科,重庆400799

出　　处：《中华麻醉学杂志》2022年第7期850-853,共4页Chinese Journal of Anesthesiology

基　　金：四川省乐山市2020年重点科技计划项目(20SZD029)。

摘　　要：目的评价潜伏期硬膜外长间歇脉冲注射技术用于分娩镇痛的效果。方法选择本院初产妇(足月单胎、头位)78例,年龄22~35岁,BMI 18.0~30.0 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用计算机随机分组法分为2组(n=39):常规硬膜外阶梯式脉冲注射组(C组)和硬膜外长间歇脉冲注射组(L组)。2组均经L2,3间隙行硬膜外穿刺,镇痛泵配方均为0.1%罗哌卡因+0.5μg/ml舒芬太尼。C组潜伏期脉冲剂量8 ml,间歇时间1 h,活跃期脉冲剂量10 ml,间歇时间1 h。L组潜伏期给予首次脉冲剂量10 ml,1.5 h后测量麻醉平面,当平面低于T10时即刻给予脉冲剂量10 ml,反之则15 min后再次评估,当间歇时间达到2 h后无论平面是否低于T10均给予脉冲剂量10 ml,活跃期脉冲剂量10 ml,间歇时间1 h。于宫口开3 cm、宫口开6 cm、宫口开全以及分娩时记录疼痛数字评分(NRS评分)。记录产程时间、镇痛泵药物总用量、下肢Bromage分级。记录新生儿出生后1、5 min Apgar评分<7分的发生情况。记录产妇不良反应发生情况和镇痛满意度评分。结果最终每组纳入30例产妇。与C组比较,L组第一产程和总产程时间明显缩短,镇痛泵药物总用量减少(P<0.01),各时点NRS评分、第二产程和第三产程时间、下肢Bromage分级、不良反应发生率以及镇痛满意度评分、新生儿Apgar评分<7分发生率差异无统计学意义(P>0.05)。结论采用硬膜外脉冲注射技术进行分娩镇痛时,潜伏期脉冲间歇延长至1.5~2.0 h可产生满意的镇痛效果,相比阶梯式给药可进一步降低镇痛药物用量,减轻对产程的影响。Objective To evaluate the efficacy of long-interval programmed intermittent epidural bolus(PIEB)during the incubation period for labor analgesia.Methods Seventy-eight nulliparous parturients who were at full term with a singleton fetus in vertex presentation,aged 22-35 yr,with body mass index of 18.0-30.0 kg/m^(2),of American Society of Anesthesiologists physical statusⅠorⅡ,were divided into 2 groups(n=39 each)using a random number table method:routine epidural bolus using a stepwise approach group(C group)and long-interval PIEB group(L group).Epidural puncture was performed at L2,3,and the analgesia solution was 0.1%ropivacaine and 0.5μg/ml sufentanil in the two groups.The parturients in group C received 8 ml pulse dose per hour during the incubation period(cervical dilatation<3 cm),and 10 ml pulse dose per hour during the active phase(cervical dilatation≥3 cm).In group L,the first pulse dose was 10 ml during the incubation period,1.5 h later the anesthesia plane was detected,and 10 ml pulse dose was immediately given when the plane was lower than T10,otherwise it was reevaluated 15 min later.After the interval time reached 2 h,a pulse dose 10 ml was given regardless of whether the plane was lower than T10,and the pulse dose 10 ml was given at 1 h interval during the active phase.The numerical rating scale scores were recorded when the cervical dilatation was 3,6 and 10 cm,and at the time of baby delivery.The duration of labor,total consumption of analgesics,and Bromage grade of lower extremities were recorded.The Apgar score<7 at 1 and 5 min after birth was recorded.The maternal adverse reactions and scores for satisfaction with analgesia were also recorded.Results Thirty puerperae were finally enrolled in each group.The first stage of labor and total duration of labor were significantly shortened,and the total consumption of analgesics was decreased in group L(P<0.01).There were no significant differences in the numerical rating scale scores at each time point,duration of second and third stages of labo

关 键 词：镇痛 硬膜外 镇痛 产科 间歇脉冲注射 

分 类 号：R714.3[医药卫生—妇产科学]