|
| 硬膜外程控间歇脉冲式分娩镇痛对母婴安全的影响 |
| Maternal and neonatal effects of programmed intermittent epidural boluses of ropivacaine with sufentanyl for labor analgesia |
| |
| DOI：10.12089/jca.2019.09.014 |
| 中文关键词: 分娩镇痛 程控间歇脉冲式输注 持续硬膜外输注；罗哌卡因 |
| 英文关键词: Labor analgesia Programmed intermittent boluses Continuous epidural infusion Ropivacaine |
| 基金项目: |
|
| 摘要点击次数: 3860 |
| 全文下载次数: 863 |
| 中文摘要: |
目的 探讨硬膜外程控间歇脉冲式分娩镇痛对母婴安全和分娩结局的影响。
方法 2017年10月至2018年9月单胎头位初产妇410例,年龄23～32岁,BMI 20～31 kg/m2,ASA Ⅱ级。根据计算机产生随机数字的奇偶性分为程控间歇脉冲输注组(PIEB组)和持续输注组(CEI组),每组205例。两组均采用硬膜外自控镇痛(PCEA),PIEB组以每次7 ml（6 ml/min）脉冲式输注,每小时1次;CEI组以7 ml/h的速度持续泵注给药。镇痛泵药物为0.08％罗哌卡因+舒芬太尼0.4 μg/ml+生理盐水,总量120 ml,PCA 7 ml,锁定时间60 min。记录产妇镇痛前、镇痛后1、2、3、4、5 h和宫口开全时VAS疼痛评分;记录按压次数、镇痛药用量、产妇镇痛满意度评分;记录第一产程和第二产程时间、催产素、器械助产、会阴侧切、产后出血>500 ml发生情况;记录中转剖宫产、新生儿窒息和脐带动脉血血气分析。
结果 镇痛后2～5 h和宫口开全时PIEB组VAS疼痛评分明显低于CEI组(P<0.05)。PIEB组按压次数和镇痛药用量明显少于CEI组(P<0.05),产妇镇痛满意度评分明显高于CEI组(P<0.05),第一产程时间明显长于CEI组(P<0.05),使用催产素明显高于CEI组(P<0.05),会阴侧切明显少于CEI组(P<0.05)。两组第二产程时间及器械助产、产后出血>500 ml发生率差异无统计学意义。两组中转剖宫产、新生儿窒息、脐带动脉血血气分析差异无统计学意义。
结论 硬膜外程控间歇脉冲式分娩镇痛效果确切,对母婴无明显不良影响。 |
| 英文摘要: |
Objective To determine the impact of programmed intermittent epidural boluses of ropivacaine with sufentanyl for labor analgesia on maternal and neonatal outcomes.
Methods A total of 410 labor parturients, aged 23-32 years, BMI 20-31 kg/m2, ASA physical status Ⅱ, with a sigleton and vertex presentation at full term from Octomber 2017 to September 2018 were identified and categorized into two groups: epidrual analgesia at 7 ml bolus per 1 hour (group PIEB) and epidrual analgesia with a continuous infusion at 7 ml/h (group CEI). The parturients were inerted with a lumbar epidural catheter (L2-3 or L3-4), loading bolus injected 10 ml mixed liquor 0.08％ ropivacaine + 0.4 μg/ml sufentanyl, and then respectively administered with 0.08％ ropivacaine with 0.4 μg/ml sufentanyl. VAS score, frequency of women requiring rescue clinician boluses, the consumption of analgesics, maternal satisfaction from analgesia, duration of labor, instrumental vaginal delivery, lateral episiotomy, oxytocin usage and neonatal outcome were recorded.
Results Compared with group CEI, after about 120 minutes of the initial loading bolus, the VAS scores, the frequency of patients required rescue clinician boluses, the proportion of lateral episiotomy were lower, the consumption of 0.08％ ropivacaine and 0.4 μg/ml sufentanyl was smaller, the score of maternal satisfaction and the usage of oxytocin were higher, the duration of first stage of labour was longer in group PIEB (P < 0.05).
Conclusion The programmed intermittent epidural boluses decreases harm to maternal without any significant neonatal adverse effects. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
