程控硬膜外脉冲式注射或连续硬膜外输注复合硬膜外自控镇痛用于分娩镇痛的比较

Comparison of programmed intermittent epidural bolus with continuous epidural infusion at different time intervals for epidural labor analgesia

中文关键词: 分娩镇痛  硬膜外注射  持续输注  患者自控硬膜外镇痛

英文关键词: Labor analgesia  Epidural infusion  Continuous infusion  Patient-controlled epidural analgesia

中文摘要:

      
目的 评价不同间隔时间行程控硬膜外脉冲式注射(programmed intermittent epidural bolus,PIEB)或连续硬膜外输注(continuous infusion epiduaral,CEI)复合PCEA用于分娩镇痛的效果。
方法 选择有分娩镇痛要求的足月初产妇186例,ASA Ⅰ或Ⅱ级,采用数字表法随机分为三组,每组62例。三组均使用首次剂量(0.125％罗哌卡因+0.4 μg/ml舒芬太尼)10 ml,镇痛泵均使用(0.08％罗哌卡因+0.4 μg/ml舒芬太尼)100 ml。PIEB1组（P1组）:5 ml/30 min,首次剂量注入30 min后开始脉冲给药;PIEB2组（P2组）:10 ml/60 min,首次剂量注入60 min后开始脉冲给药;CEI组（C组）:10 ml/h,首次剂量注入后立即开始持续给予背景剂量。三组均设置PCA量5 ml,锁定时间30 min。记录镇痛期间宫缩疼痛VAS评分、运动阻滞程度Bromage评分、VAS评分>3分的例数和（MBS）评分>1分的例数;记录最高感觉阻滞平面、镇痛药物用药总量、催产素使用量、PCEA按压次数,第一次追加药物时间、产程时间、分娩方式和产间发热的例数;记录不良反应的发生情况。
结果 三组在分娩镇痛开始后VAS评分均明显低于镇痛前,P2组VAS>3分的比率明显低于P1组和C组(P<0.05)。镇痛期间,P1组最高感觉阻滞平面明显高于P2组和C组,P2组单侧阻滞发生率明显低于C组(P<0.05)。P2组镇痛药物用药总量、PCEA按压次数明显少于,第一次追加药物时间明显长于P1组和C组(P<0.05)。P1组与P2组器械助产与产间发热的例数明显少于C组(P<0.05)。
结论 在分娩镇痛中给予首次剂量后,间隔60 min行PIEB模式注射技术,是一种更有效的给药方法。

英文摘要:

      
Objective To investigate the effects of programmed intermittent epidural bolus (PIEB) with continuous epidural infusion (CEI) at different time intervals for epidural labor analgesia.
Methods One hundred and eighty-six nulliparous parturients were randomized to the groups P1, P2 and C. Epidural infusion was given initial loading dose: 10 ml (0.125% ropivacaine with 0.4 μg/ml sufentanil), followed by maintaining dose: 0.08% ropivacaine with 0.4 μg/ml sufentanil. Group P1 was given basal infusion 5 ml per 30 min, 30 min after the initial dose; group P2 was given basal infusion of 10 ml per 60 min, 60 min after the initial dose; CEI basal infusion of 10 ml/h immediately after the initial dose; PCEA (patient-controlled epidural analgesia dose) 5 ml (lockout interval: 30 min). The baseline maternal heart rate, noninvasive arterial blood pressure, SpO2, respiratory rate, and fetal heart rate tracing were recorded. The visual analog scale (VAS) was recorded during the first stage of labor and at full cervical dilation. The degree of motor block was assessed in both lower extremities using the modified Bromage score (MBS).The maximum blocked segment, the consumption of anesthetic, delivery mode, amount of oxytocin, The number of cases of motor block and intrapartum fever, the fetal Apgar scores,adverse reactions,maternal satisfaction score were recorded.
Results The VAS obviously decreased in the three groups since receiving labor analgesia (P<0.05). The ratio of VAS score more than 3 scales in group PIEBⅡ was significantly lower than that in groups P1 and C (P<0.05). The maximum blocked segment increased in group P1, while The incidence of unilateral block was significantly decreased in group P2 (P<0.05).The total drug consumption. And the toatal number of PCA were decreased obviously in group PIEB (P<0.05). The initial PCA time was significantly prolonged in group P2 (P<0.05).The number of instrumental midwifery and intrapartum fever in group P2 were significantly lower than that in group C (P<0.05).
Conclusion Programmed intermittent epidural bolus at the beginning 60 min intervals after the initial dose for epidural labor analgesia is scientific and effective.