脉冲式全自动注药泵在硬膜外分娩镇痛中的应用

Application of pulsed automatic infusion pump in epidural labor analgesia

目的观察脉冲式全自动注药泵在分娩镇痛中临床使用及对产妇和胎儿安全性评估。方法要求行硬膜外分娩镇痛初产妇480例，随机分为脉冲式全自动注药泵组（A组）和一般全自动注药泵组（B组）。选择L2-3或L3-4行硬膜外穿刺并向头部置管4cm。注射试验剂量1．5％利多卡因3m1，5min后。A组连接脉冲式全自动注药泵，每隔1h脉冲式注药8ml，8rain内注完；B组连接一般全自动注药泵，两组均首次剂量7ml，持续剂量8ml／h，单次给药8ml，锁定时间30min。镇痛期间记录VAS、改良Bromage评分、镇痛起效时间、感觉阻滞最高平面及达到的时间、麻醉药物总量、第一次镇痛药补救时间、补救次数、产程、分娩方式、缩宫素使用量、产后出血量、不良反应发生率及新生儿评分。结果最终纳入产妇共410例，A组208例，B组202例。与镇痛前相比，两组产妇在实施分娩镇痛后VAS评分均明显降低（P〈0．05），镇痛后15min、2h、3h、4h，A组VAS评分低于B组（P〈0．05）。A组达感觉消失最高平面的时间短于B组（P〈0．05）。A组镇痛起效时间短于B组（P〈0．05），补救次数A组明显少于B组，第一次补救时间A组长于B组（P〈0．05）。镇痛药物总量A组少于B组（P〈0．05）。1min和5min时的Apgar评分两组差异无统计学意义（P〉0．05）。结论脉冲式全自动注药泵较一般全自动注药泵起效时间短，阻滞平面广，镇痛时间长和需注射镇痛药补救次数少，可提高分娩镇痛满意度。

Objective To investigate the clinical application of pulsed automatic infusion pump in the labor analgesia and evaluate the safety for parturients and neonates. Methods Four hundred and eighty nulliparae who requested analgesia for labor were recruited and randomly divided into two groups. After the catheter was inserted into epidural space, a test dose of 1.5% lidocaine （3 ml） was injected. Five minutes later, parturients in group A were given pulsed automatic infusion pumps with pulsed injection of 8 ml in 8 min and group B were given infusion automatic pumps, with loading dose 7 ml, infusion dose 8 ml/h and manual bolus dose 8 ml, lockout time 30 mins in both groups. VAS, modified Bromage score, sensory block level, total local anesthetic consumption, duration of effective analgesia, time to first bolus demand, total demands of clinical boluses, delivery time, delivery mode, amount of oxytocin, postpartum hemorrhage, the side-effects and Apgar score of neonates were recorded. Results A total of 410 participants completed the study, with 208 and 202 cases in group A and B respectively. VAS was significantly lower in two groups after receiving labor analgesia （P〈0.05）. VAS in group A was lower than that in group B at 30 min, 2 h, 3 h and 4 h after epidural analgesia （P〈0.05）. Total local anesthetic consumption, the onset time of analgesia and the number of rescue boluses were slightly lower in group A than those in group B （P〈0.05）. Time to first bolus demand in group A was longer than that in group B （P〈0.05）. The time reached the highest level of sensory block level in group A was shorter than that in group B （P〈0.05）. There was no significant difference in the other indexes between the two groups. Conclusion Application of pulsed automatic infusion pump was with shorter onset time of analgesia, higher level of sensory block, less demands of clinical boluses and higher satisfaction than the application of au- tomatic infusion pump in labor analgesia.