超声引导下竖脊肌平面阻滞麻醉用于分娩镇痛的可行性  

The feasibility of ultrasound-guided erector spinae plane block anesthesia for labor analgesia

作　　者：柴小明 张芳 陆新健[2] 夏道林 CHAI Xiaoming;ZHANG Fang;LU Xinjian;XIA Daolin(Department of Anesthesiology,Xuyi People's Hospital,Xuyi 211700,China;Department of Anesthesiology,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]江苏省盱眙县人民医院麻醉科,江苏盱眙211700 [2]东南大学附属中大医院麻醉科,江苏南京210009

出　　处：《现代医学》2023年第8期1057-1061,共5页Modern Medical Journal

基　　金：淮安市卫生健康科研立项项目(HAWJZ202104);江苏省妇幼保健科研项目(F202201)。

摘　　要：目的:初步评价超声引导下竖脊肌平面阻滞(ESPB)麻醉用于分娩镇痛的有效性及安全性。方法:本研究为随机对照研究,纳入分娩镇痛的产妇60例,随机分成ESPB组和硬膜外镇痛组。当宫颈口扩大到3 cm时,ESPB组于T9横突水平双侧给予0.25%罗哌卡因各20 ml行ESPB麻醉分娩镇痛;硬膜外镇痛组则常规行硬膜外分娩镇痛。记录产妇分娩镇痛起始之前(T0)、给予分娩镇痛30 min后(T1)、宫颈扩张至10 cm(T2)及胎儿娩出时(T3)的数字评定量表(NRS)疼痛评分及各产程时长;记录产妇的不良反应或主诉以及新生儿出生时及5 min时的Apgar评分。结果:给予ESPB麻醉30 min后产妇NRS疼痛评分均≤3分,新生儿出生时及5 min时Apgar评分均≥9分,血流动力学指标均维持在正常范围。与硬膜外镇痛组比较,ESPB组产妇生产过程中各不良反应发生率及新生儿Apgar评分未见明显差异,且ESPB组产妇的第二产程时长缩短,T1、T2、T3时间点NRS疼痛评分较低(P<0.05)。结论:超声引导下ESPB麻醉用于分娩镇痛具有良好的可行性,镇痛效果和安全性与硬膜外相当。Objective:To investigate the efficacy and safety of ultrasound-guided erector spinae plane block(ESPB)for labor analgesia.Methods:In this randomized controlled study,60 delivery women who required labor analgesia were randomly divided into ESPB group and epidural group.In ESPB group,20 ml of ropivacaine(0.25%)was given bilaterally at the T9 transverse process level for labor analgesia when the dilation of cervical was enlarged to 3 cm.Epidural labor analgesia was performed routinely in epidural group.Duration of each stage of labor in each group was registered.The numerical rating scale(NRS)pain scores were recorded at the initiation of labor analgesia(T0),30 minutes after labor analgesia(T1),the moment dilatation of cervical enlarged to 10 cm(T2),and the moment the fetus delivered(T3)in both groups.All maternal untoward effect or chief complaints were taken notes.And Apgar scores of fetuses were gathered at birth and 5 minutes after birth.Results:The NRS score of the delivery women was less than or equal to 3 at 30 minutes after ESPB analgesia,and the Apgar score of the newborns was greater than or equal to 9 at birth and 5 minutes after ESPB analgesia.The hemodynamic indexes were maintained in the normal range.Compared with the epidural group,there was no significant difference in the incidence of adverse reactions and neonatal Apgar scores during labor in the ESPB group,and the duration of the second stage of labor in the ESPB group was shorter,and the NRS pain scores at T1,T2 and T3 were significantly lower(P<0.05).Conclusion:The ultrasound-guided ESPB for labor analgesia has shown good feasibility,with its efficacy and safety equal to that of epidural analgesia.

关 键 词：分娩镇痛 竖脊肌平面阻滞 椎管内麻醉 罗哌卡因 

分 类 号：R714.3[医药卫生—妇产科学]