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| 硬膜外间歇脉冲注入技术用于分娩镇痛的效果 |
| Analgesic effect of programmed intermittent epidural bolus technique in parturient-controlled epidural labor analgesia |
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| DOI：10.12089/jca.2020.12.009 |
| 中文关键词: 分娩镇痛 罗哌卡因 舒芬太尼 硬膜外间歇脉冲注入技术 持续硬膜外输注 |
| 英文关键词: Labor analgesia Ropivacaine Sufentanil Programmed intermittent epidural bolus technique Continuous epidural infusion |
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| 中文摘要: |
目的 探讨硬膜外间歇脉冲注入技术（PIEB）在产妇自控硬膜外分娩镇痛中的效果及对分娩结局的影响。
方法 选择行硬膜外分娩镇痛的单胎、头位、足月妊娠产妇100例，年龄18～38岁，BMI 20～32 kg/m2，ASA Ⅰ或Ⅱ级，采用随机数字表法分为两组：PIEB组和连续硬膜外输注组（CEI组），每组50例。两组镇痛药配方均为0.08％罗哌卡因＋0.4 μg/ml舒芬太尼。PIEB组参数设置：脉冲频率每小时1次，剂量10 ml，注药速率400 ml/h，单次剂量10 ml，间隔20 min。CEI组参数设置：背景输注速率10 ml/h，单次剂量10 ml，间隔20 min。记录产妇分娩镇痛前、镇痛后1、2、3、5 h、宫口开全和分娩时的VAS疼痛评分；产妇首次按压时间、按压次数、镇痛泵用药总量、镇痛时间；总产程时间、产后出血量、新生儿Apgar评分、产妇对分娩镇痛效果满意度评分；感觉阻滞平面达T4的例数、改良Bromage评分；以及低血压、恶心呕吐等不良反应发生情况。
结果 与分娩镇痛前比较，分娩镇痛后两组产妇VAS疼痛评分明显降低（P<0.05）。与CEI组比较，PIEB组镇痛后2、3、5 h、宫口开全、分娩时VAS疼痛评分均明显降低（P<0.05），首次按压时间明显延迟（P<0.01），按压次数、镇痛泵用药总量明显减少（P<0.01）。与CEI组比较，PIEB组产妇满意度评分明显增高（P<0.01），感觉阻滞平面达T4的产妇比例明显升高（P<0.05）。两组总产程时间、产后出血量、新生儿Apgar评分差异无统计学意义。两组低血压和恶心呕吐等不良反应发生率差异无统计学意义。
结论 PIEB可安全有效地用于产妇自控硬膜外分娩镇痛，其效果优于连续硬膜外输注，产妇满意度高，且不影响分娩结局。 |
| 英文摘要: |
Objective To evaluate the effects of programmed intermittent epidural bolus technique (PIEB) in the treatment of parturient-controlled epidural labor analgesia and its impact on the obstetric outcomes.
Methods A total of 100 full term parturients with singleton, cephalic presentation, aged 18-38 years, BMI 20-32 kg/m2, ASA physical status Ⅰ or Ⅱ, who required labor analgesia were randomly divided into two groups: programmed intermittent epidural bolus group (group PIEB) and continuous epidural infusion group (group CEI), 50 patients in each group. Both groups were treated with 0.08% ropivacaine + 0.4 μg/ml sufentanil. Parameters of group PIEB were set as follows: pulse frequency once/h, dosage 10 ml, injection rate 400 ml/h, PCEA dosage 10 ml, locking time 20 min. Parameters of group CEI were set as follows: background infusion rate 10 ml/h, PCEA dosage 10 ml, locking time 20 min. The VAS scores of parturients before labor analgesia, 1, 2, 3, 5 h after analgesia, full cervix and delivery were recorded. First PCEA time, number of PCEA, the total amount of drugs used, analgesic time, labor process, amount of postpartum haemorrhage, neonatal Apgar score, and satisfaction score of parturients with labor analgesia effect were recorded. The maximum sensory block level, Bromage score, and adverse reactions such as hypotension, nausea and vomiting were recorded.
Results The VAS scores obviously decreased in the two groups since receiving labor analgesia (P < 0.05). Compared with group CEI, group PIEB had decreased VAS scores after 2, 3, 5 h of analgesia, full cervix and delivery (P < 0.05). Compared with group CEI, group PIEB had delayed first PCEA, decreased number of PCEA, and total amount of drugs used (P < 0.01). There were no statistical differences in labor process, postpartum hemorrhage, and neonatal Apgar score between the two groups. The satisfaction scores in group PIEB were significantly higher than that of group CEI (P < 0.01). The thoracic sensory block level proportion increased significantly in group PIEB was higher than that in group CEI (P < 0.05). There was no significantly difference of hypotension, nausea and vomiting among the two groups.
Conclusion PIEB can be used safely and effectively for parturient-controlled epidural labor analgesia, which has better efficacy than continuous epidural infusion method does, and has high satisfaction scores and no impact on the obstetric outcomes. |
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