硬脊膜穿破硬膜外阻滞在分娩镇痛中的应用效果及对产妇子宫收缩的影响  

Application effect of dural puncture epidural block in labor analgesia and its effect on uterine contraction of puerperae

作　　者：史景发[1] 张蓉[1] 高玲[2] 谢雷[1] 方向东[1] SHI Jing-fa;ZHANG Rong;GAO Ling;XIE Lie;FANG Xiang-dong(Department of Anesthesiology,Maternity and Child Health Hospital Affiliated to Anhui Medical University,Anhui Province Maternity and Child Health Hospital,Hefei 230001,Anhui,China;Center for Parturition,Maternity and Child Health Hospital Affiliated to Anhui Medical University,Anhui Province Maternity and Child Health Hospital,Hefei 230001,Anhui,China)

机构地区：[1]安徽医科大学附属妇幼保健院、安徽省妇幼保健院麻醉科,安徽省合肥市230001 [2]安徽医科大学附属妇幼保健院、安徽省妇幼保健院分娩中心,安徽省合肥市230001

出　　处：《广西医学》2022年第23期2734-2739,共6页Guangxi Medical Journal

基　　金：安徽省妇幼保健院院级科研项目(kyzd2020-1-1)。

摘　　要：目的探讨硬脊膜穿破硬膜外(DPE)阻滞在分娩镇痛中的应用效果及对产妇子宫收缩的影响。方法将200例单胎头位初产妇随机分为D组和E组,各100例。D组采用DPE阻滞进行分娩镇痛,E组采用硬膜外阻滞进行分娩镇痛。比较两组产妇分娩镇痛后疼痛数字评价量表(NRS)评分≤3分所需时间、麻醉平面达T_(10)和S_(2)所需时间,以及分娩镇痛后30 min疼痛NRS评分≤3分的产妇比例、T_(10)阻滞率、S_(2)阻滞率。比较两组产妇分娩镇痛前10 min(T 0)、分娩镇痛后10 min(T_(1))、分娩镇痛后20 min(T_(2))、分娩镇痛后30 min(T_(3))、分娩镇痛后60 min(T_(4))的宫缩持续时间、宫缩间歇时间、宫缩极期压力值。记录分娩过程中使用患者自控硬膜外镇痛(PCEA)次数、镇痛补救情况、镇痛不良反应发生率、缩宫素使用情况及分娩结局。记录两组阴道分娩产妇的各产程时间、产后2 h出血量及血清前列腺素E_(2)(PGE_(2))水平,以及新生儿出生后1 min、5 min的Apgar评分及脐动脉血气pH值。结果D组产妇分娩镇痛后疼痛NRS评分≤3分所需时间、麻醉平面达T_(10)所需时间及麻醉平面达S_(2)所需时间均短于E组,且分娩镇痛后30 min S_(2)阻滞率高于E组(均P<0.05);D组产妇镇痛过程中PCEA次数及镇痛补救比例少于或低于E组(均P<0.05),而两组产妇缩宫素使用情况、不良反应发生率及分娩方式差异无统计学意义(均P>0.05)。两组产妇的宫缩持续时间、宫缩间歇时间、宫缩极期压力值比较,差异均无统计学意义(均P>0.05);与T 0比较,D组T_(1)、T_(2)、T_(3)的宫缩持续时间均缩短、宫缩极期压力值均降低,T_(3)宫缩间歇时间延长(均P<0.05);与T 0比较,E组T_(2)、T_(3)的宫缩持续时间均缩短、宫缩极期压力值均降低(均P<0.05)。两组阴道分娩产妇各产程时间、产后2 h出血量、血清PGE_(2)水平及新生儿相关指标比较,差异均无统计学意义(均P>0.05)。结论与硬膜外�Objective To investigate the application effect of dural puncture epidural(DPE)block in labor analgesia and its effect on uterine contraction of puerperae.Methods A total of 200 primiparas with singleton fetus and vertex presentation at birth were randomly divided into group D or group E,with 100 cases in each group.Group D received DPE block for labor analgesia,while group E received epidural block for labor analgesia.The time to post-labor analgesia Numerical Rating Scale(NRS)score for pain≤3,and to post-labor analgesia anesthesia planes reaching T_(10)and S_(2),as well as the proportion of puerperae with NRS score for pain≤3,T_(10)block rate,and S_(2)block rate after 30 minutes of labor analgesia were compared between the two groups.Duration of uterine contraction,interval time of uterine contraction,pressure value of uterine contraction during acme before 10 minutes of labor analgesia(T 0),after 10 minutes of labor analgesia(T_(1)),after 20 minutes of labor analgesia(T_(2)),after 30 minutes of labor analgesia(T_(3)),and after 60 minutes of labor analgesia(T_(4))were compared between the two groups.The times for patient-control extradural analgesia(PCEA)use,analgesic remedy,incidence rate of analgesic adverse reactions,oxytocin use,and delivery outcome of puerperae during labor were recorded.The duration of various labor stages,bleeding volume 2 hours after labor and serum prostaglandin E_(2)(PGE_(2))level of the puerperae undergoing vaginal delivery in the two groups,and the Apgar scores 1 minute and 5 minutes after birth and umbilical artery blood gas pH value of the newborns were recorded.Results The time to post-labor analgesia NRS score for pain≤3,and to post-labor analgesia anesthesia planes reaching T_(10)and S_(2)in group D were shorter than those in group E,and the 30-minute post-labor analgesia S_(2)block rate in group D was higher than that in group E(all P<0.05);furthermore,the times for PCEA and analgesic remedy proportion of puerperae during analgesia were less or lower in group D than in g

关 键 词：分娩镇痛 硬脊膜穿破硬膜外阻滞 硬膜外阻滞 子宫收缩 分娩结局 

分 类 号：R714.7[医药卫生—妇产科学]