不同脉冲间隔时间行程控硬膜外脉冲式注射对分娩镇痛的影响  

Effect of programmed intermittent epidural bolus at different interval time for labor analgesia

作　　者：胡翠霞 王君 李珍[1] 陈亮[1] HU Cuixia;WANG Jun;LI Zhen;CHEN Liang(Department of Anesthesiology,Hunan Provincial Maternal and Child Health Care Hospital,Changsha,Hunan 410008,China)

机构地区：[1]湖南省妇幼保健院麻醉科,湖南长沙410008

出　　处：《中国医学工程》2024年第12期49-53,共5页China Medical Engineering

基　　金：湖南省卫生计生委科研计划课题(202204113351)。

摘　　要：目的观察不同间隔时间行程控硬膜外脉冲式注射(PIEB)和连续硬膜外输注(CEI)对于分娩镇痛效果的影响。方法选择要求行分娩镇痛的单胎足月顺产初产妇229例,采用数字表法随机分为三组:PIEB模式间隔30 min组(P30组,n=77)、PIEB模式间隔60 min组(P60组,n=76)和CEI模式组(C组,n=76)。产妇侧卧位于L3-4间隙行硬膜外穿刺,均使用首次剂量0.08%罗哌卡因+0.3μg/mL舒芬太尼混合镇痛液10 mL。P30组给药间隔30 min,单次脉冲剂量5 mL,P60组给药间隔60 min,单次脉冲剂量10 mL,C组10 mL/h恒速输注。镇痛泵配方为0.08%罗哌卡因+0.3μg/mL舒芬太尼共150 mL,PCEA量5 mL,锁定时间10 min。观察镇痛前、镇痛后1 h、2 h、3 h、4 h、宫口开全时、分娩时宫缩视觉模拟评分法(VAS)评分和Bromage评分。记录有效自控硬膜外镇痛(PCEA)次数、硬膜外用药总量、产程时间及不良反应的发生情况。结果三组产妇在分娩镇痛开始后VAS评分均低于镇痛前(P<0.05)。P30组和P60组镇痛后3 h、4 h、宫口开全及分娩时VAS评分低于C组(P<0.05),P60组宫口开全及分娩时VAS评分低于P30组(P<0.05)。P30组和P60组镇痛用药总量和有效PCEA次数低于C组(P<0.05),P60组有效PCEA次数低于P30组(P<0.05)。P60组满意度高于P30和C组(P<0.05)。三组产程时间、Bromage评分、不良反应发生率差异无统计学意义。结论PIEB用于分娩镇痛可达到更好的镇痛效果,且间隔60 min行PIEB模式注射是一种更理想的给药方法。【Objective】To compare the clinical efficacy of programmed intermittent epidural bolus(PIEB)with continuous epidural infusion(CEI)at different interval time for labor analgesia.【Methods】A total of 229 primiparous full-term singleton pregnant women requiring labor analgesia were randomly divided into three groups:PIEB mode at an interval of 30 min group(group P30,n=77),PIEB mode at an interval of 60 min group(group P60,n=76)and traditional CEI mode group(group C,n=76).Epidural catheters was placed at the L3-4 interspace with the subject in lateral position.Epidural solution was 0.08%ropivacaine and 0.3μg/mL sufentanil,and the initial loading dose was 10 mL.PIEB regimens were programmed as bolus 5 mL per 30 min starting from 30 min after analgesia began in group P30 and bolus 10 mL per 60 min starting from 60 min after analgesia began in group P60.Group C received continuous infusion at 10 mL/h immediately when analgesia began.The patient-controlled epidural analgesia(PCEA)dose was 5 mL with a 10 minutes lockout.The drugs used in the pump were 0.08%ropivacaine and 0.3μg/mL sufentanil in three groups.Visual Analog Scale(VAS)scores and modified Bromage scores were recorded before labor analgesia,1,2,3 and 4 hours after labor analgesia,at full dilation of the cervix and during delivery.The consumption of anesthetic,the number of pressing of self-controlled analgesia pump,and occurrence of adverse reactions were recorded.【Results】The VAS scores obviously decreased in the three groups since receiving labor analgesia(P<0.05).Compared with group C,the VAS scores of group P30 and group P60 were decreased 3 and 4 hours after labor analgesia,at full dilation of the cervix and during delivery(P<0.05).The VAS scores of group P60 at the uterus fully opened and delivery were lower than those in group P30(P<0.05).The total drug consumption and the number of PCEA were decreased obviously in group P30 and group P60(P<0.05).The effective frequency of PCEA in group P60 was less than that in group P30(P<0.05).The analgesi

关 键 词：分娩镇痛 硬膜外阻滞 程控硬膜外脉冲式注射 

分 类 号：R614[医药卫生—麻醉学]