不同程控间歇硬膜外脉冲输注速度对分娩镇痛效果的影响  

Effect of different programmed intermittent epidural infusion speed on labor analgesia

作　　者：熊立娜 马骏[1] 徐铭军[3] XIONG Lina;MA Jun;XU Mingjun(Department of Anesthsiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心,100029 [2]首都医科大学附属北京妇产医院怀柔妇幼保健院 [3]首都医科大学附属北京妇产医院麻醉科

出　　处：《临床麻醉学杂志》2023年第2期145-149,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察不同程控间歇硬膜外脉冲输注(PIEB)速度对分娩镇痛效果的影响。方法选择采用PIEB方式镇痛的单胎产妇163例,年龄20~35岁,BMI 21~29 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将产妇分为三组:低速度组(L组,n=50)、中速度组(M组,n=55)和高速度组(H组,n=58)。产妇侧卧位于L_(2-3)间隙行硬膜外穿刺,均使用首次剂量0.1%罗哌卡因+0.5μg/ml舒芬太尼混合镇痛液8~10 ml,30 min后连接电子脉冲泵。电子脉冲泵配方:0.1%罗哌卡因+0.5μg/ml舒芬太尼混合镇痛液100 ml。参数设置:脉冲剂量8 ml/次,间隔时间1 h,PCA 6 ml,间隔时间20 min。L组、M组和H组的脉冲速度分别为200、400、600 ml/h。记录分娩镇痛前、镇痛后30 min、1、2、3、4 h、宫口开全时宫缩VAS疼痛评分和硬膜外相关产时发热(ERMF)的发生情况。记录下肢运动阻滞程度(改良Bromage评分)、PCA总按压次数、有效按压次数、局麻药物总用药量和镇痛时间。结果三组不同时点宫缩VAS疼痛评分、ERMF发生率差异无统计学意义。三组改良Bromage评分均为0级,均未出现运动阻滞。三组PCA总按压次数、有效按压次数、局麻药物用药总量和镇痛时间差异无统计学意义。结论不同程控间歇硬膜外脉冲输注速度的分娩镇痛效果无明显差异。Objective To observe the effects of labor analgesic with different speed of programmed intermittent epidural bolus(PIEB).Methods A total of 163 term parturients with singleton received labor analgesia with PIEB,aged 20-35 years,BMI 21-29 kg/m^(2),ASA physical statusⅠorⅡ,were randomly divided into three groups:low speed group(group L,n=50),medium speed group(group M,n=55)and high speed group(group H,n=58),74 patients in each group.Epidural catheters was placed at the L_(2-3) interspace with the subject in lateral position.Epidural solution was 0.1%ropivacaine and 0.5μg/ml sufentanil,and the initial loading dose was 8-10 ml.Electronic pulse pump formula was consisted of 0.1%ropivacaine+0.5μg/ml sufentanil mix analgesia 100 ml.Parameters were set as follows:pulse dose 8 ml/time,interval 1 hour,PCA 6 ml,interval 20 minutes.The pulse speeds of groups L,M,and H were 200,400,and 600 ml/h,respectively.The VAS pain score of contraction and epidural-related intrapartum fever(ERMF)were recorded before labor analgesia,30 minutes,1,2,3,and 4 hours after labor analgesia.Lower extremity motor block(modified Bromage score),total number of PCA compressions,effective times of PCA compressions,total amount of local anesthetics and analgesic time were recorded.Results There were no significant difference in VAS pain score of contraction and incidence of ERMF among the three groups at different time points.The modified Bromage scores in the three groups were all 0,and no motor block occurred.There were no significant differences in the total number of PCA compressions,effective number of PCA compressions,total amount of local anesthetics and analgesic time among the three groups.Conclusion There is no significant difference in the effect of labor analgesia at different speeds of PIEB.

关 键 词：分娩镇痛 程控间歇硬膜外脉冲输注 硬膜外阻滞 脉冲输注速度 产时发热 

分 类 号：R714.3[医药卫生—妇产科学]