不同剂量1.5%氯普鲁卡因缓解分娩镇痛爆发痛的效果  

Effect of epidural injection with different doses of 1.5%chloroprocaine in relieving breakthrough pain during labor analgesia

作　　者：计天珍 徐成 刘红霞 李国防 李锐[3] 朱海娟 JI Tianzhen;XU Cheng;LIU Hongxia;LI Guofang;LI Rui;ZHU Haijuan(Department of Anesthesiology,Anhui Provincial Maternal and Child Health Hospital,Hefei 230011,China;Department of Anesthesiology,Shanghai Jiaotong University Affiliated Sixth People's Hospital;Department of Anesthesiology and Perioperative Medicine,the Second Hospital of Anhui Medical University)

机构地区：[1]安徽省妇幼保健院麻醉科,230011 [2]上海交通大学附属第六人民医院麻醉科 [3]安徽医科大学第二附属医院麻醉与围术期医学科

出　　处：《天津医药》2023年第10期1146-1152,共7页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(82100315)。

摘　　要：目的探讨1.5%氯普鲁卡因硬膜外注射量缓解分娩镇痛中爆发痛的效果。方法选择硬膜外麻醉分娩镇痛后出现爆发痛的初产妇128例,随机分为R组、C_(1)组、C_(2)组和C_(3)组。出现爆发痛时,R组硬膜外注射0.15%罗哌卡因6 mL,C_(1)组、C_(2)组、C_(3)组硬膜外分别注射1.5%氯普鲁卡因6、8、10 mL。给药后每隔3 min对产妇进行1次疼痛视觉模拟评分(VAS)评估镇痛效果。记录主要观察指标:爆发痛给药起效时间和爆发痛治疗的成功率。次要观察指标:补救镇痛率;产妇满意度(爆发痛给药后5 min、胎儿娩出后24 h);首次爆发痛发生时(T_(0))、给药后3 min(T_(1))、6 min(T_(2))、9min(T_(3))、12 min(T_(4))、15 min(T_(5))、18 min(T_(6))的疼痛VAS、改良Bromage评分、胎心率(FHR);爆发痛时、给药后第2、4、6、8、10、12次宫缩的间隔和持续时间;1、5 min时Apgar评分;不良反应。结果Kaplan–Meier曲线结果显示R组、C_(1)组、C_(2)组、C_(3)组爆发痛给药后的中位起效时间(95%CI)分别为14.3(13.4~15.2)min、6.6(5.6~7.6)min、5.9(5.0~6.8)min和4.7(3.9~5.4)min,C_(3)组爆发痛给药起效时间快于C_(1)组(Log-rankχ^(2)为9.852,P<0.05)和C_(2)组(Log-rankχ^(2)为5.325,P<0.05)。与R组比,C_(2)、C_(3)组爆发痛治疗成功率、爆发痛给药后5 min和胎儿娩出后24 h的产妇满意度升高,C_(3)组补救镇痛率下降(P<0.01);与C_(1)组比,C_(3)组爆发痛治疗成功率升高,补救镇痛率下降,C_(2)、C_(3)组爆发痛给药后5 min和胎儿娩出后24 h的产妇满意度提高(P<0.01)。T_(1)时,C_(2)、C_(3)组疼痛VAS低于R组,C_(3)组低于C_(1)组(P<0.05);T_(2—5)时,C_(1)、C_(2)、C_(3)组疼痛VAS低于R组,C_(2)、C_(3)组疼痛VAS低于C_(1)组(P<0.05);T_(6)时,C_(2)、C_(3)组疼痛VAS显著低于R和C_(1)组(P<0.05)。4组宫缩间隔时间、宫缩持续时间差异无统计学意义。与R组和C_(1)组相比,C_(3)组爆发痛给药30 min内下肢麻木发生率升高(P<0.05)。4组间改良Bromage评分�Objective To investigate the effect of epidural injection of 1.5%chloroprocaine on breakthrough pain during labor analgesia.Methods A total of 128 primiparas with breakthrough pain after epidural labor analgesia were randomly divided into four groups(R,C_(1),C_(2)and C_(3)groups).When breakthrough pain occurred,0.15%ropivacaine 6 mL was injected epidural in the group R,and 1.5%chloroprocaine 6,8 and 10 mL were injected epidural in the group C_(1),the group C_(2)and the group C_(3),respectively.The visual analogue score(VAS)for pain was assessed every 3 minutes after the administration of local anesthetics.The primary outcome was recorded including the onset time of breakthrough pain after the administration and the success rate of breakthrough pain treatment.Secondary outcome included rescue analgesia rate,maternal satisfaction(5 minutes after administration of breakthrough pain,24 hours after the delivery),VAS,modified Bromage score,fetal heart rate(FHR)at first breakthrough pain(T_(0)),3 min(T_(1)),6 min(T_(2)),9min(T_(3)),12 min(T_(4)),15 min(T_(5))and 18 min(T_(6))after administration,the interval and duration of uterine contraction at the onset time of breakthrough pain,the second,fourth,sixth,eighth,tenth and twelfth contractions after administration,Apgar score in 1 and 5 min and adverse reactions.Results Kaplan-Meier survival analysis showed that the median onset time(95%CI)of breakthrough pain in the group R,the group C_(1),the group C_(2)and the group C_(3)were 14.3(13.4-15.2)min,6.6(5.6-7.6)min,5.9(5.0-6.8)min and 4.7(3.9-5.4)min,respectively.The onset time of administration was significantly faster in the group C_(3)than that in the group C_(1)and the group C_(2)(Log-rankχ^(2)was 9.852 and 5.325,P<0.05).Compared with the group R,the success rate of breakthrough pain treatment and maternal satisfaction(5 minutes after administration,24 hours after the delivery)were significantly increased in the group C_(2)and the group C_(3),and remedial analgesia rate was significantly decreased in the group C_(3)(P

关 键 词：分娩疼痛 爆发性疼痛 镇痛 产科 镇痛 硬膜外 氯普鲁卡因 起效时间 

分 类 号：R614[医药卫生—麻醉学]