分娩镇痛中硬脊膜穿破硬膜外阻滞效果及对产程和应激炎症反应的影响  

Effect of the epidural perforating epidural block and epidural block used for the painless labor and its influence on the labor stage and the inflammatory response and stress

作　　者：潘郑斌 陈皆锋[1] 丁洁岚[1] 潘轶瑜 水维维 PAN Zhengbin;CHEN Jiefeng;DING Jielan;PAN Yiyu;SHUI Weiwei(Shaoxing Maternal and Child Health Care Hospital,Zhejiang Province,312000)

机构地区：[1]浙江省绍兴市妇幼保健院,312000

出　　处：《中国计划生育学杂志》2024年第11期2545-2550,共6页Chinese Journal of Family Planning

基　　金：绍兴市卫生健康科技计划项目(2023SKY050);浙江省绍兴市妇幼保健院医学重点学科建设资金(绍兴妇保2021-46号)。

摘　　要：目的:探究硬脊膜穿破硬膜外阻滞(DPE)和硬膜外阻滞在分娩镇痛中的应用效果。方法:选择2023年12月-2024年7月在本院接受无痛分娩的产妇80例,随机数字表法分为对照组(n=40,采用硬膜外阻滞分娩镇痛)和观察组(n=40,采用DPE分娩镇痛),比较两组镇痛(VAS评分)、神经阻滞、分娩及产程情况,宫缩持续时间、间隔时间,以及产妇血清和脐带血皮质醇、白介素1β、白介素8水平,统计并发症发生情况。结果:观察组宫缩时的镇痛效果优于对照组,且随着时间推移观察组宫缩时的VAS评分更低(P<0.05);镇痛后0.5h至停药时,两组间VAS评分无差异(P>0.05),且未受到时间及交互作用影响,镇痛效果差异不显著(P>0.05);观察组使用罗哌卡因用量(50.44±5.16mg)少于对照组(50.44±5.16mg),双侧感觉阻滞平面至S2占比(95.0%)高于对照组(72.5%)(均P<0.05),两组双侧感觉阻滞平面至T10占比、不对称阻滞发生率及更换导管发生率无差异(P>0.05);观察组使用缩宫素比例(15.0%)低于对照组(52.5%)(P<0.05),两组第一和第二产程时间、产后出血发生均无差异(P>0.05);两组宫缩持续时间、宫缩间歇时间差异均不显著,且未受到组间和时间交互作用的影响(P>0.05);时间对两组的宫缩持续时间有显著影响(P>0.05),但对两组宫缩间隔时间均无影响(P>0.05);分娩镇痛完成1h时,观察组血清及脐带血皮质醇、白介素1β、白介素8水平均低于对照组(P<0.05)。两组不良反应无差异(P>0.05)。结论:分娩镇痛宫缩期间,DPE技术表现出优于传统硬膜外阻滞的镇痛效果,能够减少麻醉药物使用量,减轻应激和炎症反应,且对产程无影响,安全性较好。Objective:To explore the application analgesia effect of the epidural perforating epidural block(EPEB)and epidural block used for the painless labor of pregnant women.Methods:80pregnant women who wanted painless labor in the hospital were included and were randomly divided into two groups by the random number table method from December 2023 to July 2024.40 women in the control group received epidural block for the painless labor,and 40 women in the study group received EPEB for the painless labor.The pain relief situation evaluated by VAS score,the status of neural blockade,delivery and labor stage,the duration and the interval time of the uterine contractions,and the levels of the serum and umbilical cord blood cortisol,interleukin(IL)-1β,and IL-8 of the women were compared between the two groups.The incidences of complications of the women in the two groups were counted.Results:The analgesic effect for the uterine contraction of the women in the study group was significantly better than that of the women in the control group,and the VAS score of the women in the study group at the uterine contraction had decreased significantly over time(P<0.05).There was no significant difference in the VAS score of the women from 0.5hafter analgesia to the drug withdrawal between the two groups(P>0.05),and the analgesic effect of the women in the two groups was not affected by the time and the interaction,and the difference of the analgesic effect of the women had no significantly different between the two groups(P>0.05).The amount of ropivacaine used(50.44±5.16mg)of the women in the study group was significantly less than that(50.44±5.16mg)of the women in the control group,and the proportion of bilateral sensory block level to S2(95.0%)of the women in the study group was significantly higher than that(72.5%)of the women in the control group(all P<0.05).There were no significant differences in the proportion of the bilateral sensory block level to T10,and the incidences of asymmetric block and catheter replacement of the w

关 键 词：无痛分娩 硬脊膜穿破硬膜外阻滞 硬膜外阻滞 应激炎症反应 宫缩 

分 类 号：R714.3[医药卫生—妇产科学]