程控硬膜外间歇脉冲注入技术与持续硬膜外输注在剖宫产术后快速康复中效果的比较  

Programmed Intermittent Epidural Bolus in Comparison with Continuous Epidural Infusion for the Effects of Enhanced Recovery after Cesarean Section

作　　者：莫晓飞 黄发 曾洁群 陈天宇 何耿兴 陈景晖 刘文兴 MO Xiao-fei;HUANG Fa;ZENG Jie-qun;CHEN Tian-yu;HE Geng-xing;CHEN Jing-hui;LIU Wen-xing(Department of Anesthesiology,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心麻醉科,广东广州510623

出　　处：《中山大学学报（医学科学版）》2023年第1期93-98,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81870823);广州市妇女儿童医疗中心/广州市儿科研究所基金(GCP-2018-001)。

摘　　要：【目的】比较程控硬膜外间歇脉冲注入技术(PIEB)与持续硬膜外输注(CEI)在剖宫产术后快速康复中的效果。【方法】择期行剖宫产术患者120例,年龄18~45岁,单胎,足月妊娠(≥37周),ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为程控硬膜外间歇脉冲注入组(PIEB组)与持续硬膜外输注组(CEI组),每组60例。术毕两组患者通过硬膜外导管给予相同镇痛首剂后实施硬膜外镇痛。PIEB组在首次剂量注入30分钟后,开始PIEB模式,6 mL·h^(-1);CEI组首次剂量注入后立即开始CEI模式,6 mL·h^(-1)。镇痛泵中均使用0.1%罗哌卡因。于术后2、6、12、24和36h采用VAS评分评估患者的整体疼痛情况,采用Bromage score评分评估双侧下肢的运动阻滞程度;记录术后首次肛门排气的时间、首次下床活动的时间和麻醉满意度评分。【结果】PIEB组术后12、24和36 h VAS评分及术后6、12和24 h下肢Bromage评分均低于CEI组,差异有统计学意义(P<0.01)。PIEB组术后12 h~24 h使用的硬膜外镇痛剂量较CEI组减少,差异有统计学意义(P=0.002)。PIEB组首次肛门排气时间和下床活动时间短于CEI组,麻醉满意度高于CEI组,差异有统计学意义(P<0.05)。两组在拔除尿管后首次排尿时间以及住院天数比较差异无统计学意义(P>0.05)。【结论】与CEI相比,PIEB可为剖宫产患者提供更好的术后镇痛、降低术后运动阻滞评分、减少硬膜外镇痛用药量、缩短术后首次排气时间和首次下床活动的时间,并提高患者的满意度,更有利于患者术后早期的康复。【Objective】 To compare the effects of programmed intermittent epidural bolus(PIEB) and continuous epidural infusion(CEI) on enhanced recovery after cesarean section.【Methods】 Totally 120 women scheduled to undergo elective cesarean section under combined spinal and epidural anesthesia, aged 18-45 years, with single fetus, full-term pregnancy (≥37 weeks), ASA grade II or III, were recruited, with 60 cases in each group. At the end of the surgery, after a similar epidural loading dose, patients were randomLy assigned to receive either PIEB(6 mL·h^(-1)beginning 30 minutes after the loading dose) or CEI(6 mL·h^(-1), beginning immediately after the loading dose) for the maintenance of analgesia with 0.1% ropivacaine. At 2, 6, 12, 24 and 36 h postoperatively, VAS score was used to evaluate the composite pain, and Bromage Score was used to evaluate the degree of lower extremity motor block. The time to first flatus, time to first ambulation and the satisfaction scores were also recorded.【Results】 The VAS scores at 12, 24 and 36 h postoperatively and the lower extremity motor block scores at 6, 12 and 24 h postoperatively in the PIEB group were significantly lower than those in the CEI group(P < 0.01). The epidural analgesic dosage was less in the PIEB group than that of the CEI group(P=0.002). The time to first flatus and time to first ambulation were significantly shorter than those in the CEI group(P <0.05). The satisfaction scores were significantly higher in the PIEB group than in the CEI group(P < 0.05). There was no significant difference in the first urination time after urinary catheter removal and the length of hospital stay between the two groups(P > 0.05).【Conclusion】 Compared with CEI, PIEB provides better postoperative analgesia, less motor block scores, lower epidural analgesic dosage, shorter the time to first flatus and defecation and time to first ambulation, and greater patient satisfaction, which is more consistent with the ERAS concept of analgesia.

关 键 词：镇痛 硬膜外 剖宫产 运动阻滞 程控硬膜外间歇脉冲注入 

分 类 号：R714.7[医药卫生—妇产科学]