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| 不同脉冲间隔时间程控硬膜外间歇脉冲注入模式对分娩镇痛效果的影响 |
| Effect of programmed intermittent epidural bolus at different interval time for labor analgesia |
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| DOI：10.12089/jca.2022.10.004 |
| 中文关键词: 分娩镇痛 硬膜外阻滞 程控硬膜外间歇脉冲注入 |
| 英文关键词: Labor analgesia Epidural block Programmed intermittent epidural bolus |
| 基金项目:温州市医药卫生科研项目（2020040） |
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| 中文摘要: |
目的 比较不同脉冲间隔时间下程控硬膜外间歇脉冲注入（PIEB）模式和持续恒速输注（CEI）模式用于分娩镇痛的临床效果。
方法 选择单胎妊娠、头位、足月初产妇95例，年龄20～40岁，ASA Ⅱ或Ⅲ级，孕期37～41周，随机分为三组：传统CEI模式组（C组，n=31）、PIEB模式间隔时间60 min组（P60组，n=32）和PIEB模式间隔时间40 min组（P40组，n=32）。在宫口扩张至1～4 cm时，采用硬膜外阻滞行分娩镇痛，注射负荷量后15 min为产妇镇痛开始时间。C组于镇痛开始后立即开启CEI模式，持续以10 ml/h恒速输注。P60组于镇痛开始后60 min开启PIEB模式，单次脉冲10 ml，脉冲间隔时间60 min。P40组于镇痛开始后40 min开启PIEB模式，单次脉冲10 ml，脉冲间隔时间40 min。镇痛泵配方为0.075%罗哌卡因+0.5 μg/ml舒芬太尼100 ml，单次按压量5 ml，锁定时间15 min。记录镇痛前（t0）、镇痛后1 h（t1）、镇痛后2 h（t2）、宫口开全（t3）和胎儿娩出时（t4）VAS疼痛评分、Bromage评分，记录t1—t4时胸段及腰骶段感觉阻滞平面。记录镇痛药物用量、PCA有效按压次数以及不良反应的发生情况。
结果 与t0时比较，t1—t4时C组、P60组和P40组VAS疼痛评分明显降低（P<0.05）。与C组比较，t2—t4时P60组和P40组VAS疼痛评分明显降低（P<0.05）。与P60组比较，t3、t4时P40组VAS疼痛评分明显降低（P<0.05）。与t1时比较，t2—t4时C组胸段阻滞平面明显降低，t3、t4时P60组和P40组胸段阻滞平面明显降低（P<0.05）；t2—t4时三组腰骶段阻滞平面明显升高（P<0.05）。与C组比较，t2—t4时P60组和P40组胸段阻滞平面明显升高，腰骶段阻滞平面明显降低（P<0.05）。与P60组比较，t3、t4时P40组胸段阻滞平面明显升高，腰骶段阻滞平面明显降低（P<0.05）。与C组比较，P60组和P40组PCA有效按压次数明显减少（P<0.05）。与P60组比较，P40组PCA有效按压次数明显减少（P<0.05）。三组镇痛药物用量、Bromage评分、不良反应发生率差异无统计学意义。
结论 与CEI模式相比，PIEB用于分娩镇痛可达到更好的镇痛效果，并且40 min间隔时间优于60 min。 |
| 英文摘要: |
Objective To compare the clinical efficacy of programmed intermittent epidural bolus (PIEB) at different interval time for labor analgesia.
Methods A total of 95 singleton, cephalic, full-term primiparas, aged 20-40 years, ASA physical status Ⅱ or Ⅲ, gestational weeks 37-41, were randomly divided into three groups: traditional CEI mode group (group C, n = 31), PIEB mode at an interval of 60 min group (group P60, n = 32), and PIEB mode at an interval of 40 min group (group P40, n = 32). Fifteen minutes after initial bolus dose was regarded as the beginning of analgesia. PIEB regimens were programmed as bolus 10 ml/h starting from 1 h after analgesia beginning in group P60 and bolus 10 ml per 40 min starting from 40 min after analgesia began in group P40. Group C received continuous infusion at 10 ml/h immediately when analgesia began. The patient-controlled bolus dose was 5 ml with a 15 minutes lockout. The drugs used in the pump were 0.075% ropivacaine and 0.5 μg/ml sufentanil in three groups. Visual analog scale (VAS) scores and modified Bromage scores were recorded before labor analgesia (t0), 1 hour after labor analgesia (t1), 2 hours after labor analgesia (t2), the uterus fully opened (t3), the fetus delivered (t4). The maximum sensory block level was recorded at t1-t4. The total consumption of drugs, the number of pressing of self-controlled analgesia pump, and occurrence of adverse reactions were recorded.
Results Compared to t0, VAS scores were significantly decreased at t1-t4 in groups C, P60 and P40 (P < 0.05). Compared with group C, VAS scores at t2-t4 were significantly decreased in groups P60 and P40 (P < 0.05). Compared with group P60, VAS scores at t3 and t4 were significantly decreased in group P40 (P < 0.05). Compared to t1, parturients had a lower cephalad sensory block at t2-t4 in group C and at t3 and t4 in groups P60 and P40, meanwhile they had a less caudal sensory block at t2-t4 in all the groups (P < 0.05). Compared with group C, parturients in groups P60 and P40 developed a more cephalad and caudal sensory block at t2-t4(P < 0.05). Compared with group P60, parturients in group P40 developed a more cephalad and caudal sensory block at t3 and t4(P < 0.05). Compared with group C, the number for PCA pressing were less in groups P60 and P40 than in group C (P < 0.05). There was no significant difference in the total drug consumption, Bromage scores and occurrence of adverse reactions among the three groups.
Conclusion PIEB provides reliable efficacy for labor analgesia and an interval time of 40 min will decrease PCA pressing without increasing the occurrence of adverse reactions. |
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