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| 不同硬膜外镇痛模式对肥胖产妇镇痛效果和分娩方式的影响 |
| Effects of two epidural analgesia modes on analgesic effect and delivery mode in obese parturients |
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| DOI：10.12089/jca.2019.10.003 |
| 中文关键词: 硬膜外分娩镇痛 分娩方式 肥胖产妇；镇痛效果 |
| 英文关键词: Epidural laboranalgesia Delivery mode Obese parturients Analgesic effect |
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| 中文摘要: |
目的 比较两种硬膜外镇痛模式对肥胖产妇镇痛效果和分娩方式的影响。
方法 回顾性分析2013—2016年本院肥胖产妇586例,年龄21～43岁,BMI 30～41 kg／m2,ASA Ⅱ或Ⅲ级,按照镇痛模式分为两组，每组105例:连续硬膜外输注组(CEI组)和间歇脉冲硬膜外输注组(IEB组)。两组均事先配置硬膜外注射混合液0.08％罗哌卡因+0.45 μg／ml舒芬太尼200 ml。CEI组:背景剂量6 ml／h,PCEA剂量6 ml,注药速率为60 ml／h,锁定时间30 min;IEB组:脉冲频率每小时1次,剂量6 ml,注药速率400 ml／h,PCEA剂量6 ml,锁定时间30 min。应用SPSS 22.0中倾向性评分匹配（PSM）模块，采用1∶1最近邻匹配法、设定卡钳值为0.01进行倾向性匹配分析。记录镇痛前、镇痛后10、30 min和宫口开全时NRS评分;记录产程时间、分娩方式;记录镇痛药物总量、PCEA追加次数、PCEA有效次数和新生儿1、5 min Apgar评分;记录镇痛期间不良反应的发生情况。
结果 宫口开全时IEB组NRS评分明显低于CEI组［(3.8±0.7) 分 vs (4.2±0.7) 分, P＜0.05］。IEB组三个产程时间明显长于CEI组(P＜0.05),PCEA追加次数及PCEA有效次数明显少于CEI 组(P＜0.05)。两组分娩方式、镇痛药物总量、新生儿Apgar评分和不良反应发生率差异无统计学意义。
结论 IEB模式为肥胖产妇提供良好的镇痛效果,不影响分娩方式,可安全有效地用于肥胖产妇联合PCEA进行分娩镇痛。 |
| 英文摘要: |
Ojective To compare the effects of two epidural analgesia modes on analgesic effect and delivery mode of obese parturients.
Methods A total of 586 obese parturients, aged 21-43 years, BMI 30-41 kg／m2, falling into ASA physical status Ⅱ or Ⅲ, were selected from 2013 to 2016 in our hospital, were divided into continuous epidural infusion group (group CEI, n = 105) and intermittent epidural bolus group (group IEB, n = 105). In each group, 0.08％ ropivacaine+0.45 μg／ml sufentanil 200 ml epidural injection mixture was prepared in advance. Group CEI received continuous infusion of 6 ml／h, PCEA dose of 6 ml (injection rate of 60 ml／h), locking time 30 min; group IEB received pulse frequency one time per hour, dose of 6 ml (injection rate of 400 ml／h), PCEA dose of 6 ml, locked time 30 min. The propensity score matching module in SPSS 22.0 was utilized to do the propensity score matching by using the nearest neighbor matching. The matching proportion was 1∶1 and the calipers value was set as 0.01. The NRS scores before analgesia, 10, 30 min after analgesia and full cervical dilation was analyzed. The duration of labor, delivery mode, dosage of analgesics, PCEA supplemental frequencies, PCEA effective frequencies, neonatal Apgar scores and adverse reactions during analgesia were all recorded.
Results The NRS scores in group IEB was significantly lower than that in group CEI ［(3.8 ± 0.7) scores vs (4.2 ± 0.7) scores, P ＜ 0.05］. The duration of three labor stages in group IEB were significantly longer than that in group CEI (P ＜ 0.05). There was no significant difference in delivery mode between the two groups. The supplemental frequencies and effective frequencies PCEA in group IEB were significantly less than that in group CEI (P ＜ 0.05). There were no statistically significant differences in the dosage of analgesics, neonatal Apgar scores and incidence of adverse reactions.
Conclusion IEB model provides productive analgesic effect for obese parturients without affecting delivery mode.IEB can be safely and effectively used in obese women with PCEA for labor analgesia. |
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