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| 低背景剂量联合大剂量PCA在产妇硬膜外分娩镇痛中的应用 |
| Application of low background dose combined with high dose PCA in parturient epidural labor analgesia |
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| DOI：10.12089/jca.2018.09.003 |
| 中文关键词: 分娩镇痛 硬膜外镇痛 低背景剂量 |
| 英文关键词: Labor analgesia Epidural analgesia Low background dose |
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| 中文摘要: |
目的 观察在持续输注联合硬膜外自控给药模式下低背景剂量持续输注联合大剂量PCA的参数设置对分娩镇痛临床效果的影响。
方法 选择自愿接受分娩镇痛足月、单胎和头位初产妇120例, 年龄25～35岁, 体重58～86 kg, ASA Ⅰ或Ⅱ级, 随机分为两组：常规组（A组）和低背景剂量组（B组）。在宫口扩张2～3 cm时采用硬膜外分娩镇痛。每组均事先配置硬膜外注射混合液0.1％罗哌卡因+2 μg/ml芬太尼100 ml。A组为常规组, 背景剂量6 ml/h, PCA 5 ml, 间隔40 min;B组为低剂量组, 背景剂量2 ml/h, PCA 10 ml, 间隔为40 min。记录产妇镇痛前、镇痛后10 min、30 min、1 h、2 h、宫口开全时和分娩时VAS评分及改良Bromage评分；记录PCA追加次数；记录爆发痛例数；记录硬膜外混合液的用量；记录镇痛时间、产程时间、分娩方式；记录不良反应的发生情况和新生儿Apgar评分。
结果 镇痛期间两组产妇VAS评分差异无统计学意义；接受镇痛期间B组混合液用量(40.5±7.5) ml；明显少于A组(60.3±12.0) ml(P<0.05)；B组PCA实际追加次数(1.6±0.9)次明显少于A组(3.0±1.8)次(P<0.05)。两组产妇的产程、镇痛时间、爆发痛例数、不良反应发生率、产妇分娩方式和新生儿Apgar评分差异无统计学意义。
结论 采用低背景剂量(2 ml/h)联合大剂量PCA(10 ml, 间隔40 min)的硬膜外自控镇痛参数设置不仅没有降低镇痛效果, 还可减少硬膜外腔用药总量。 |
| 英文摘要: |
Ojective To explore the clinical effect of low dose background infusion combined with high dose PCA for patient controlled epidural labor analgesia.
Methods A total of 120 full term nulliparous women, aged 25 - 35 years, weighing 58 - 86 kg, ASA physical status Ⅰ or Ⅱ were included, who received successful epidural labor analgesia during the first labor phrase with the cervix dilation 2 - 3 cm. They were randomized into group A and group B. In each group, 0.1％ ropivacaine+2 μg/ml fentanyl 100 ml epidural injection mixture was prepared in advance. Group A received continuous infusion of 6 ml, PCA of 5 ml, at an interval time of 40 min, group B received continuous infusion of 2 ml, PCA of 10 ml, at an interval time of 40 minutes, The maternal VAS scores before analgesia, after analgesia 10 min, 30 min, 1 h, 2 h, full cervical dilation, delivery were observed. Blood pressure, VAS scores, modified Bromage scores, PCA supplemental frequency, mixture dosage, breakthrough pain numbers, duration of labor, duration of analgesia, mode of delivery, adverse reactions, and neonatal Apgar scores were all recorded.
Results There was no statistically significant difference in VAS scores between the two groups during the analgesia period. The dosage of mixture (40.5 ± 7.5) ml in group B during the analgesia period was significantly lower than that in group A (60.3 ± 12.0) ml (P<0.05). The actual PCA supplementation times of group B (1.6 ± 0.9) were significantly less than that of group A (3.0 ± 1.8). There were no statistically significant differences between the two groups in maternal delivery duration, analgesia time, numbers of breakthrough pain, incidence of adverse reactions, maternal delivery mode and neonatal Apgar scores.
Conclusion The parameter setting of for epidural automatic analgesia pump of low background dose (2 ml/h) combined with high dose PCA of 10 ml at an interval of 40 min does not reduce the analgesia effect, moreover it reduces the total amount of epidural analgesia. |
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