预置硬膜外导管对分娩镇痛效果和母婴安全的影响

Effect of preset epidural catheter on labor analgesia and maternal and child safety

目的观察预置硬膜外导管实施分娩镇痛的效果及对母婴安全的影响。方法选择单胎、头位、足月、有镇痛需求的初产妇364例,年龄22~30岁,BMI 25~30 kg/m^2,随机分为两组:预置管组(n=180)在出现规律宫缩、宫颈接近消失后硬膜外穿刺置管,产妇自觉疼痛剧烈要求镇痛时开始镇痛;常规组(n=184)在出现规律宫缩、宫口开大1 cm后开始硬膜外穿刺置管镇痛。两组镇痛液配方均为0.075%罗哌卡因+舒芬太尼0.5μg/ml。记录分娩镇痛的有效性评分,包括镇痛开始时的VAS评分、镇痛起效时间(从产妇要求镇痛到疼痛缓解的时间)和镇痛期间最高VAS评分;分娩期间补救镇痛情况,以及产程时间、新生儿1 min和5 min Apgar评分,产间发热情况等。结果与常规组比较,预置管组镇痛开始时的VAS评分明显降低[3(2~4)分vs 5(4~5)分,P<0.05],镇痛起效时间明显缩短[(18.45±7.05)min vs (33.2±10.51)min,P<0.05],但镇痛期间最高VAS评分差异无统计学意义[4(2~6)分vs 4(2~6)分],预置管组的有效性评分明显较高[4(3~5)分vs 3(2~4)分,P<0.05]。两组产妇产程时间、出血量、镇痛泵按压次数、补救次数、产妇发热比例及新生儿Apgar评分差异无统计学意义。结论硬膜外预置管可以提高分娩镇痛的有效性,且不影响产程和母婴安全,是一种值得推广的分娩镇痛模式。

Objective To evaluate the effect of preset epidural catheter for labor analgesia and its impact on maternal and child safety. Methods A total of 364 primiparas with singleton, head, full-term, aged 22-30 years, BMI 25-30 kg/m^2, were randomly divided into two groups: the primiparas in group P(n = 180) received epidural puncture and placed the catheter during latent phase(the maternal perceives regular contractions), initiated analgesia when required;those in group C(n = 184) started epidural analgesia when cervix dilatation ≥1 cm. The analgesic of the two groups was 0.075% ropivacaine + sufentanil 0.5 μg/ml. The effectiveness score for labor analgesia were recorded, which include the VAS before analgesia, the onset time of analgesia(from the time the mother requested analgesia to pain relief), and the highest VAS during analgesia. The analgesic supplement doses during childbirth, the duration of labor, the 1 min and 5 min Apgar score of the newborn, and the fever during childbirth were also recorded. Results The VAS score before analgesia [3(2-4) vs 5(4-5), P < 0.05] and the onset time(18.45 ± 7.05 min vs 33.2 ± 10.51 min, P < 0.05) of group P was lower than those of group C, the highest VAS was equivalent between the two groups [4(2-6) vs 4(2-6)]. The effectiveness score of group P was significantly higher than that of group C [4(3-5) vs 3(2-4), P < 0.05]. There were no significant differences in labor duration, bleeding volume, analgesic supplement doses, maternal fever ratio, and neonatal Apgar score between the two groups. Conclusion Preset epidural catheter can improve the effectiveness score of labor analgesia without affecting the labor duration and maternal and child safety. It’s a worth promoting mode of labor analgesia.