硬脊膜穿破硬膜外阻滞联合程控硬膜外间隙脉冲给药模式在经产妇分娩镇痛中的应用效果  

The Application Effect of Dural Puncture Epidural Block Combined with Programmed Intermittent Epidural Bolus Mode in Pain Alleviation during Multipara Delivery

作　　者：华静[1] 牛江峰 邓群[1] 周群[1] HUA Jing;NIU Jiangfeng;DENG Qun;ZHOU Qun(Department of Anesthesiology,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China;不详)

机构地区：[1]江西省妇幼保健院麻醉科,江西南昌330006

出　　处：《中国医学创新》2024年第13期6-10,共5页Medical Innovation of China

基　　金：江西省卫生健康委科技计划项目(202130791)。

摘　　要：目的:评价硬脊膜穿破硬膜外(DPE)阻滞联合程控硬膜外间隙脉冲给药(PIEB)模式在经产妇分娩镇痛中的应用效果及对新生儿的影响。方法:选择2023年3—4月江西省妇幼保健院自然分娩行椎管内分娩镇痛的孕37~42周、单胎头位、美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级的经产妇180例。采用在线随机数生成器将产妇分为三组:DPE阻滞联合PIEB模式组(DPE+PIEB组,60例)、DPE阻滞联合连续硬膜外输注(CEI)模式组(DPE+CEI组,60例)和单纯硬膜外(EP)阻滞联合CEI模式组(EP+CEI组,60例)。比较三组产妇在30 min内达“满意镇痛”的时长、30 min后无满意镇痛手动推药发生率、镇痛效果和阻滞情况、不良反应和胎儿娩出情况。结果:DPE+PIEB组和DPE+CEI组产妇达满意镇痛时长快于EP+CEI组(P<0.05)。三组产妇罗哌卡因总消耗量为:DPE+PIEB组<DPE+CEI组<EP+CEI组(P<0.05),阻滞平面上限均达T_(10)。三组产妇Bromage评分均为0分,产程总时长、导管更换率、瘙痒、头痛、神经损伤发生率和胎儿心动过缓发生率比较差异均无统计学意义(P>0.05),新生儿出生后1 min和5 min时Apgar评分≤7分的发生率均为0。结论:DPE阻滞联合PIEB模式用于经产妇的分娩镇痛可明显缩短药物起效时间,增强镇痛效果,减少罗哌卡因用量,不影响产程进展,且对新生儿无不良影响。Objective:To evaluate the effect of dural puncture epidural(DPE)block combined with programmed intermittent epidural bolus(PIEB)mode in multipara labor analgesia and its effect on neonates.Method:A total of 180 multipara aged 37-42 weeks,single fetal head position,and classified as classⅠorⅡby the American society of anesthesiologists(ASA)from March to April 2023 at Jiangxi Maternal and Child Health Hospital were selected to undergo intraspinal delivery analgesia.Using an online random number generator,postpartum women were divided into three groups:the DPE block combined with PIEB mode group(DPE+PIEB group,60 cases),the DPE block combined with continuous epidural infusion(CEI)mode group(DPE+CEI group,60 cases),and the simple epidural(EP)block combined with CEI mode group(EP+CEI group,60 cases).The duration of achieving"satisfactory analgesia"within 30 minutes,the incidence of manual medication administration without satisfactory analgesia after 30 minutes,the analgesic effect and blocking situation,adverse reactions,and fetal delivery among three groups of postpartum women were compared.Result:Satisfactory anesthesia was achieved faster in the DPE+CEI group and DPE+PIEB group than that in the EP+CEI group(P<0.05).The total consumption of Ropivacaine in the three groups was:DPE+PIEB group<DPE+CEI group<EP+CEI group(P<0.05).The upper limit of the block plane was T_(10)in three groups.The Bromage score of all three groups was 0;there were no significant differences in the total duration of labor,maternal catheter replacement rate,pruritus,headache,nerve injury,and fetal bradycardia among the three groups(P>0.05).The incidence of Apgar score≤7 scores at 1 min and5 min after birth in all three maternal newborn groups was 0.Conclusion:DPE block combined with PIEB mode for multipara labor analgesia can significantly shorten the onset time of medication,enhance the analgesic effect,reduce the amount of Ropivacaine,does not affect the progress of labor and has no adverse effects on newborns.

关 键 词：硬脊膜穿破硬膜外阻滞 程控硬膜外间隙脉冲给药模式 分娩镇痛 经产妇 

分 类 号：R714.3[医药卫生—妇产科学]