机械泵持续硬膜外注射与电子脉冲泵间歇性注射麻醉剂对分娩镇痛效果的比较

Comparison of analgesic effect of continuous epidural injection of anesthetic with mechanical pump and intermittent injection of anesthetic with electronic pulse pump

目的观察自发分娩的产妇采用机械泵持续性硬膜外注射(CEI)和电子脉冲泵间歇性硬膜外注射(PIEB)分娩镇痛的临床效果及安全性。方法回顾性选取2019年1~9月昆山市第四人民医院收治的美国麻醉师学会(ASA)健康评级为Ⅰ级或Ⅱ级、要求分娩镇痛的足月(≥37周)产妇80例,随机数字表法将其分为两组:CEI组和PIEB组,每组各40例。CEI组产妇首先硬膜外腔注射8 ml 0.1%甲磺酸罗哌卡因联合0.4μg/ml舒芬太尼的初始加载剂量进行首剂剂量,再以2 ml/h的速度进行CEI;PIEA组产妇接受10 ml/h(10q60)的0.1%甲磺酸罗哌卡因联合0.4μg/ml舒芬太尼进行PIEB镇痛。分娩过程中间隔20 min使用疼痛视觉模拟评分(VAS)进行评分,比较两组麻醉剂用量,统计新生儿Apgar评分并记录第二产程持续时间和患者满意度。结果两组患者整个分娩期间平均疼痛评分相比,无显著性差异(P> 0.05)。PIEB组额外使用的麻醉剂用量(31.274±9.615 mg)明显低于CEI组(50.440±12.783mg),差异有显著性(P=0.001);PIEB组产妇满意度评分(2.151±0.848分)相明显高于CEI组(1.715±0.961分),差异有显著性(P=0.008);两组产妇分娩中的Bromage评分、第二产程时间以及Apgar评分相比,均无显著性差异(P>0.05)。结论程序化的PIEB镇痛相较于CEI镇痛可改善分娩镇痛效果,缩短产程,减小分娩风险,提高患者满意度。

Objective To observe the clinical effect and safety of labor analgesia of Continuous Epidural Infusions (CEI) and Programmed Intermittent Epidural Boluses (PIEB) for parturient women.Methods Random number table was used to select 80 full-term (≥37weeks) pregnant women who received the American College of Anesthesiologists (ASA) health rating of Ⅰ or Ⅱ and required labor analgesia in Kunshan City Fourth People’s Hospital from January to September 2019 and divide into two groups:CEI group and PIEB group,40 cases in each group.In the CEI group,women in the epidural space were first injected with an initial loading of 8 ml of 0.1%ropivacaine mesylate combined with an initial loading dose of 0.4μg/ml sufentanil for CEI at a rate of 2 ml/h;The group of women received 10 ml/h (10 q60) of 0.1%ropivacaine mesylate combined with 0.4μg/ml sufentanil for PIEB analgesia.The visual analogue scale of pain (VAS) was used for scoring at intervals of 20 minutes during labor.The Apgar score of newborns was counted and the duration of the second stage of labor and patient satisfaction were recorded.Results Although there was no significant difference in the average pain score between the two groups during the whole delivery period (P>0.05).The additional anesthetic dosage (31.274±9.615 mg) in PIEB group was significantly lower than that in CEI group (50.440±12.783 mg),with significant difference (P=0.001).The PIEB group’s maternal satisfaction score (2.151±0.848) was significantly higher than CEI group’s (1.715±0.961),with significant difference (P=0.008).There was no significant difference in Bromage score,second stage of labor and Apgar score between the two groups (P>0.05).Conclusion PIEB can improve labor analgesia,shorten labor period,reduce labor risk,and increase patient satisfaction compared with mechanical CEI.