椎管内分娩镇痛的优化管理  

Optimizing the management of neuraxial labor analgesia

作　　者：杜唯佳 刘志强 DU Weijia;LIU Zhiqiang(Department of Anesthesiology,Shanghai First Maternity and Infant Hospital,School of Medicine,Tongji University,Shanghai 200040,China)

机构地区：[1]同济大学附属第一妇婴保健院麻醉科,上海200040

出　　处：《同济大学学报（医学版）》2023年第2期157-165,共9页Journal of Tongji University(Medical Science)

基　　金：上海市科学技术委员会优秀学术带头人项目(22XD1402400);上海市浦东新区医疗联合项目(PDYLT2022-03);上海市浦东新区联合攻关项目(PW2021D-01)。

摘　　要：椎管内分娩镇痛技术使母婴受益远大于风险,已成为产妇首选的产时镇痛方式。随着椎管内穿刺技术的发展、输注技术的改良和药物的合理应用,镇痛质量得到改善的同时各种并发症的发生率也在不断降低。大量研究致力于比较不同穿刺定位技术、硬膜外导管材质和开孔、新型输注技术以及药物配伍的临床效果,旨在进一步提高分娩镇痛质量,探索出最佳的分娩镇痛模式。本文聚焦椎管内穿刺定位技术、硬膜外导管设计、输注技术改良和硬膜外腔药物的合理应用,结合相关国内外循证医学依据,进一步探讨椎管内分娩镇痛的优化管理。It is now widely accepted that neuraxial anesthesia brings more benefit than harm to mothers and babies,it has become the first choice for labor analgesia worldwide.With the development of new techniques and drugs for initiation and maintenance of labor analgesia,the safety and the quality of labor analgesia have been dramatically improved over the last decades.As researchers continue to search for the ideal labor analgesia,newer technologies are evolving to make epidural analgesia safer and individualized.In order to optimize the management of neuraxial labor analgesia,this review will focus on recent advances in labor analgesia,including methods for identification of the epidural space,the epidural catheter design,techniques used for maintenance of labor analgesia and drugs for epidural analgesia to provide evidence-based reference for its clinical application.

关 键 词：分娩镇痛 椎管内镇痛 硬膜外导管 程控间歇硬膜外脉冲 

分 类 号：R614[医药卫生—麻醉学]