摘要
目的:观察硬脊膜穿破硬膜外阻滞技术(DPE)联合程控硬膜外间歇脉冲注入模式(PIEB)在分娩镇痛中的临床应用效果及安全性。方法:选择单胎头位初产妇120例,随机分为硬膜外阻滞组(EP组)和硬脊膜穿破硬膜外阻滞组(DPE组)(n=60)。选取L2-L3间隙为椎管内麻醉穿刺点,EP组穿刺成功后启动硬膜外自控镇痛(PCEA),持续输注剂量10 mL/h。DPE组硬膜外穿刺成功后,用腰麻针刺破硬脊膜,不进行蛛网膜下腔给药,退出腰麻针,置管后连接脉冲式全自动注药泵,持续剂量5 mL/h,随后每隔1 h自动脉冲式注药一次5 mL;两组镇痛泵麻醉药液均为0.08%盐酸罗哌卡因+0.4μg/mL舒芬太尼,首次剂量8 mL,自控镇痛量5 mL,锁定时间30 min。比较两组产妇镇痛前(T0)、镇痛后30 min(T1)、1h(T2)、分娩时(T3)视觉模拟评分法(VAS)评分;记录两组产妇镇痛起效时间、产程、镇痛泵患者自控镇痛(PCA)按压次数及麻醉药物使用总量;记录两组患者不良反应发生率及1 min新生儿Apgar评分。结果:两组产妇T0、T1、T2时点VAS评分差异无统计学意义(P>0.05);DPE组T3时点VAS评分小于PE组,差异有统计学意义(P<0.05);DPE组镇痛起效时间快,PCA按压次数、镇痛药液总量比PE组减少,差异有统计学意义(P<0.05);两组产妇总产程及1min新生儿Apgar评分,不良反应的发生率,差异均无统计学意义(P>0.05)。结论:DPE联合PIEP技术用于分娩镇痛,具有更好的镇痛效应,起效时间短,药物总量少,优势明显。
Objective:To observe the clinical application and safety of dural punctwre epidwral block fechnique(DPE)combined with program-controlled epidural intermittent pulse injection(PIEB)in labor analgesia.Methods:120 cases of parturient with single head position were randomly divided into epidural block group(EP group)and epidural block group(DPE group)(n=60).The L2-L3 space was selected as the intraspinal puncture point.In the EP group,epidural patient controlled analgesia(PCEA)was initiated after successful puncture,and the continuous infusion dose was 10 mL/h.In the DPE group,after the epidural puncture was successful,the dural mem brane was broken with lumbar acupuncture,and the injection liquid was not pushed into the subarachnoid space,the lumbar acupuncture needle was withdrawn,and a cephalic tube was placed to connect the pulse automatic injection pump with a continuous doseof 5 mL/h,and then automatic pulse injection of 5mL every 1 hour.The analgesic pump anesthetic liquid in both groups was 0.08%ropivacaine hydrochloride+0.4ug/mL sufentanil,and the first dose was 8 mL,the self-controlled analgesic dose was5 mL,and the locking time was 30 min.Visual analogue scores(VAS)were compared before analgesia(T0),30min after analgesia(T1),1h(T2)and during delivery(T3).The effective time of analgesia,labor course,patient controlled analgesia(PCA)compress times and total narcotic dosage were recorded in the two groups.Adverse reactions such as headache,respiratory depression,bypotension were recorded in both groups,as well as Apgar scores at 1 min of neonates.Results:There was no significant difference in VAS scores at T0,T1 and T2 time between the two groups(P>0.05).At T3 time VAS score of DPE group was lower than that of PE group,and the difference was statistically significant(P<0.05).There were no significant differences in total labor duration,Apgar score of 1 min between the:two groups,and the incidence of adverse reactions(P>0.05).The analgesic onset time in DPE group was faster,The PCA compress times and the total amount of analgesic liquid was lower than those in PE group,the difference was statistically significant(P<0.05)。Conclusion:DPE combined with PIEP technique for labor analgesia has better analgesic efect,short onset time,less total drug,and obvious advantages.
作者
刘亚利
甘美勤
LIU Yali;GAN Meiqin(Department of Anesthesiology,Kaifeng Obstetrics and Gynecology Hospital,Kaifeng 475000,CHN)
出处
《河南大学学报（医学版）》
CAS
2024年第3期195-198,共4页
Journal of Henan University:Medical Science
关键词
硬脊膜穿破硬膜外阻滞技术
程控硬膜外间歇脉冲注入模式
分娩镇痛
dural puncture epidural block technique
program controlled epidural intermittent pulse injection mode
labor analgesia
作者简介
通信作者:刘亚利(1981-)主治医师。研究方向:妇儿麻醉,E-mail:xiaoxue6881@126.com。
