比较三种硬膜外麻醉给药方案对足月初产妇分娩镇痛及不良反应的影响

Comparison on the effect and adverse reaction of three methods of epidural infusion modes in labor analgesia of patients

目的探讨两种不同注射速度的规律间断硬膜外泵注(RIEB)和持续性硬膜外输注(CEI)复合患者自控硬膜外镇痛(PCEA)用于分娩镇痛的效果及不良反应。方法选择上海市长宁区妇幼保健院2017年6月至2019年1月自愿接受分娩镇痛的初产妇255例,按照随机数字表法分为A、B、C三组,每组85例。所有产妇给予硬膜外分娩镇痛,镇痛液配方为0.08%罗哌卡因+0.4μg/ml舒芬太尼。A组产妇予以CEI模式镇痛,10 ml/h持续输注。B组与C组产妇予以RIEB模式镇痛,自注射首剂后75 min开始,间断1 h给予10 ml镇痛液,其中B组的注射速度为2 ml/min,C组的注射速度为6 ml/min。记录各组镇痛前(T1)、镇痛后1 h(T2)、宫口开大7~8 cm时(T3)、分娩时(T4)的体温、疼痛视觉模拟量表(VAS)评分、罗哌卡因、舒芬太尼用量和PCEA有效按压次数,比较两组产程时间、镇痛时间、分娩方式、新生儿Apgar评分及不良反应发生情况。结果三组患者各时点体温比较差异无统计学意义(P>0.05)。三组患者T1、T2时点VAS评分比较差异无统计学意义(P>0.05),T3、T4时点VAS评分C组<B组<A组[T3:(1.4±0.5)分<(2.5±0.5)分<(3.1±0.6)分;T4:(1.8±0.5)分<(2.8±0.4)分<(3.7±0.7)分],组间比较差异均有统计学意义(P<0.05)。C组产妇PCEA有效按压次数、罗哌卡因用量、舒芬太尼用量低于A、B组(P<0.05),B组低于A组(P<0.05)。三组第一产程时间、第二产程时间、镇痛时间比较差异无统计学意义(P>0.05)。三组分娩情况、新生儿Apgar评分及不良反应发生率比较差异无统计学意义(P>0.05)。结论RIEB复合PCEA用于分娩镇痛的效果显著,且泵注速度为6 ml/min可有效减少PCEA追加次数和罗哌卡因用量、舒芬太尼用量,并且未增加不良反应,对产程也无影响。

Objective To compare the effects and adverse reaction of regular intermittent epidural bolus(RIEB)and continuous epidural infusion(CEI)combined with patient-controlled epidural analgesia(PCEA)on labor analgesia.Methods The clinical data of 255 patients in C.N.Maternity&Infant Health Hospital from June 2017 to January 2019 who had underwent labor analgesia were randomized into group A,B and C,with 85 cases in each group.Epidural analgesia was used for all the patients,through L3-4 intervertebral space with 0.08%ropivacaine and 0.4μg/ml sulfentanylas epidural analgesic solution.In group A,CEI mode of analgesia was applied with 10 ml/h continuous infusion of analgesic solution.In the other two groups,RIEB mode of analgesia was used and after the first dose of 60 min,10 ml analgesic solution was injected epidural every one hour at the speed of 2 ml/min in group B and 6 ml/min in group C respectively.The body temperature and visual analogue scale(VAS)score before analgesia(T1),60 min after labor anesthesia(T2),at the time of datively cervix to 7-8 cm(T3)and at labor(T4)were compared among three groups.The frequency of PCEA request,ropivacaine consumption,sufentanil consumption,total delivery duration,analgesic time,delivery mode,neonatal Apgar score and adverse reactions were compared too.Results The body temperature at each time points had no significant differences(P>0.05).The VAS scores at T3,T4 in C group was the most highest,and then in B group was more higher,in A group was the lest,and there were significant differences among the three groups[T3:(1.4±0.5)scores<(2.5±0.5)scores<(3.1±0.6)scores;T4:(1.8±0.5)scores<(2.8±0.4)scores<(3.7±0.7)scores](P<0.05).The frequency of PCEA request,ropivacaine consumption,sufentanil consumption in C group were lower than those in B group and A group,the levels of above in B group were lower than those in A group,and there were significant differences(P<0.05).There was no significant differences in total delivery time,analgesic time,delivery mode,neonatal Apgar score and adverse reactions among the three groups(P>0.05).Conclusions RIEB combined with PCEA is effective in labor analgesia,and the pump speed of 6 ml/min can effectively decrease the need of PCEA and the dosage of analgesics without additional adverse reactions.