罗哌卡因复合舒芬太尼程控硬膜外脉冲式注入应用于分娩镇痛的临床研究

Clinical investigation on the labor analgesic effect of ropivacaine combined with sufentanil administered through programmed intermittent epidural boluses

目的:探讨通过程控硬膜外间歇脉冲注入联合患者自控镇痛(Programmed Intermittent Epidural Boluses with Patient Controlled Epidural Analgesia,PIEB+PCEA)给药方式输注罗哌卡因复合舒芬太尼的分娩镇痛效果以及对运动阻滞程度、产程情况、母婴安全等方面的影响。方法:选择2018年6月—2019年12月于惠州市中医医院和惠州市妇幼保健计划生育服务中心两家医院要求硬膜外分娩镇痛的足月初产妇100例,随机分为2组,观察组(n=50)采用PIEB+PCEA给药方式,对照组(n=50)采用持续背景输注联合患者自控镇痛(Continuous Epidural Infusion with Patient Controlled Epidural Analgesia,CEI+PCEA)给药方式,比较两组分娩镇痛效果相关指标、产程情况及新生儿Apgar评分等。结果:T3~T5时点观察组VAS评分低于对照组(P<0.05);观察组产妇满意度评分高于对照组(P<0.05),运动阻滞发生率、PCEA使用率、用药总量和器械助产率均低于对照组(P<0.05),两组产程时间、新生儿Apgar评分、催产素使用比例、会阴侧切率及中转剖宫产比例差异无统计学意义。结论:罗哌卡因配伍舒芬太尼行脉冲式自控泵复合患者自控给药模式用于硬膜外阻滞分娩镇痛效果确切,能够降低运动阻滞发生率、减少孕妇按压需求和药物用量,镇痛效果更好,产妇满意度更高,对新生儿无明显不良影响。

Objective:To study the analgesic effect during labor and the impact on motor block,labor process and the safety of mother and infant of ropivacaine combined with sufentanil administered through programmed intermittent epidural boluses with patient controlled epidural analgesia(PIEB+PCEA).Methods:A total of 100 primiparous women who requested epidural analgesia for labor in Huizhou Traditional Chinese Medicine Hospital and Huizhou Maternal and Child Health Care Family Planning Service Center from June 2018 to December 2019.The subjects were randomly divided into two groups:the observation group(n=50)received PIEB with PCEA,and the control group(n=50)received CEI(Continuous Epidural Infusion with Patient Controlled Epidural Analgesia)with PCEA.The labor analgesia effect,labor process and newborn Apgar score were compared between the two groups.Results:Between T3 and T5,the VAS score of the observation group was lower than that of the control group(P<0.05);the satisfaction score of the observation group was higher than that of the control group(P<0.05);the incidence of motor block,PCEA use rate,the total amount of drugs used and the rate of instrument-assisted delivery were all lower than that of the control group(P<0.05);there was no significant statistical difference in the duration of delivery,newborn Apgar score,oxytocin use rate,lateral episiotomy rate and conversion to cesarean section between the two groups(P<0.05).Conclusion:Ropivacaine combined with sufentanil administered through PIEB with PCEA demonstrates clear labor analgesia effect,which can reduce the incidence of motor block,reduce the pressure demand and drug dosage for women in labor.This approach has good analgesic effect,yields higher satisfaction in women in labor,has no obvious adverse effect on newborns,and thus is recommended for clinical application.