硬脊膜穿破硬膜外阻滞联合脉冲式输注用于低浓度罗哌卡因分娩镇痛的效果  

Analysis of the effect of dural perforating epidural block combined with pulse infusion of low-concentration ropivacaine for labor analgesi

作　　者：胡启雅 周亚丽 孟凡青 刘伟 郭亚秋 HU Qiya;ZHOU Yali;MENG Fanqing;LIU Wei;GUO Yaqiu(Department of Anesthesiology,Qilu Hospital,Shandong University,Jinan 250063,China;Department of Obstetrics,Jinan Maternal and Child Health Hospital affiliated with Shandong First Medical University,Jinan 250218,China;Department of Anesthesiology,Jinan Maternal and Child Health Hospital affiliated with Shandong First Medical University,Jinan 250218,China)

机构地区：[1]山东大学齐鲁医院麻醉科,济南250063 [2]山东第一医科大学附属济南妇幼保健院产科,济南250218 [3]山东第一医科大学附属济南妇幼保健院麻醉科,济南250218

出　　处：《济宁医学院学报》2024年第5期387-390,共4页Journal of Jining Medical University

基　　金：济南市卫生健康委员会科技计划项目(2023-2-108);山东省妇幼保健协会科技创新项目(SFYXH-2023Y027)。

摘　　要：目的观察硬脊膜穿破硬膜外阻滞联合脉冲式输注技术用于分娩镇痛的临床效果。方法选择2023年10月—2023年12月要求行分娩镇痛的足月单胎妊娠产妇200例,随机分为硬脊膜穿破硬膜外阻滞联合脉冲式输注(DPE-PIEB)组和硬膜外阻滞联合脉冲式输注(EP-PIEB)组,每组各100例。DPE-PIEB组在行硬膜外腔穿刺后给予腰麻针穿破硬脊膜,观察到脑脊液流出后拔出腰麻针后置入硬膜外导管,EP-PIEB组采用硬膜外腔穿刺后置入硬膜外导管,两组均给予0.1%罗哌卡因+0.4μg/mL舒芬太尼镇痛。记录产妇身高、体重和孕周等一般资料,观察两组产妇达到疼痛数字评分法(Numeric Rating Scale,NRS)≤3的时间,30min后未到达NRS≤3例数、镇痛泵按压次数,不同产程时间,新生儿5min Apgar评分以及产后发热、瘙痒、恶心呕吐等不良反应发生情况。结果两组产妇NRS≤3的时间(17.21±3.11,19.87±2.95)min、30min后未到达NRS≤3的例数和镇痛泵自控按压次数,差异有统计学意义(P<0.05),新生儿5min Apgar评分(9.14±1.01,9.00±0.25)分,差异无统计学意义(P>0.05)。结论硬脊膜穿破硬膜外阻滞联合脉冲式输注可安全有效地用于分娩镇痛,镇痛效果更好。Objective To observe the clinical effect of dural puncture and epidural block combined with pulse infusion technique for labor analgesia.Methods 200 full-term singleton pregnant women requiring labor analgesia were randomly divided into DPE group and EP group,with 100 cases in each group.In the DPE group,the needle was used to puncture the dura mater after the epidural puncture.After the cerebrospinal fluid was removed,flew out the spinal needle,and the epidural catheter was inserted into the epidural catheter.In the EP-PIED group,an epidural catheter was inserted after epidural puncture.In both groups,0.1%ropivacaine+0.4μg/mL sufentanyl was used for analgesia.Record maternal height and weight age,and observe the time of NRS≤3 during the procedure,number of cases that did not reach the NRS 3 after 30min,the analgesic pump pressing times,lower limb motor function(modified Bromage score),and puerperal fever,itching,nausea and vomiting and other adverse reactions,and record newborn 5min Apgar score.Results There were statistically significant differences(P<0.05)between the two groups in terms of the time to reach NRS≤3(17.21±3.11 vs.19.87±2.95 minutes),the number of cases that did not reach NRS≤3 after 30 minutes,and the number of times the analgesia pump was pressed.However,there was no statistically significant difference(P>0.05)in the 5-minute Apgar score of the newborns(9.14±1.01 vs.9.00±0.25).Conclusion Dural puncture epidural block combined with pulsed infusion can be used safely and effectively for labor analgesia with faster onset time and better effect.

关 键 词：硬脊膜穿破硬膜外阻滞 脉冲式输注 分娩镇痛 舒芬太尼 

分 类 号：R614.42[医药卫生—麻醉学]