硬膜外分娩镇痛给药方式对初孕产妇产后尿潴留发生的影响:程控间歇脉冲注射与连续输注的比较

Effect of epidural labor analgesia administration methods on occurrence of postpartum urinary retention in nulliparous parturients: a comparison between programmed intermittent epidural bolus and continuous epidural infusion

目的:通过比较程控间歇脉冲注射与连续输注,评价硬膜外分娩镇痛给药方式对初孕产妇产后尿潴留发生的影响。方法:足月单胎、头位初孕产妇200例,年龄22~35岁,BMI 22.4~42.6 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=100):连续硬膜外输注组(CEI组)和程控硬膜外间歇脉冲注射组(PIEB组)。于第一产程宫口开至1 cm时实施产妇自控硬膜外镇痛(PCEA),负荷量0.1%罗哌卡因+0.5μg/ml舒芬太尼的混合液10 ml,PCEA剂量5 ml,锁定时间30 min,镇痛泵药液配方为0.08%罗哌卡因+0.5μg/ml舒芬太尼混合液100 ml。CEI组给予负荷量后即刻给予背景量,输注速率8 ml/h;PIEB组负荷量后60 min,开始脉冲注入给药,80 s注入8 ml,1次/h。胎儿娩出后即刻停止给药。记录产程持续时间、镇痛泵药液用量和产后尿潴留发生的情况。结果:与CEI组比较,PIEB组第二产程持续时间缩短,镇痛泵药液用量减少,产后尿潴留发生率降低(P<0.05)。结论:与连续硬膜外输注比较,程控硬膜外间歇脉冲注射分娩镇痛用于初孕产妇产后尿潴留发生率降低。

Objective To evaluate the effect of epidural labor analgesia administration methods on occurrence of postpartum urinary retention in nulliparous parturients through a comparison between programmed intermittent epidural bolus(PIEB)and continuous epidural infusion.Methods Two hundred nulliparous parturients who were at full term with a singleton fetus in vertex presentation,of American Society of Anesthesiologists physical statusⅠorⅡ,aged 22-35 yr,with body mass index of 22.4-42.6 kg/m^(2),were divided into 2 groups(n=100 each)using a random number table method:continuous epidural infusion group(group CEI)and group PIEB.Patient-controlled epidural analgesia(PCEA)was performed in active phase of labor(cervical dilatation≥1 cm)during the first stage of labor.The PCEA solution contained the mixture(10 ml)of 0.1%ropivacaine with 0.5μg/ml sufentanil.The PCEA pump was set up to deliver a 5-ml bolus dose with a 30-min lockout interval.The analgesia solution contained the mixture(100 ml)of 0.08%ropivacaine and sufentanil 0.5μg/ml.In group CEI,the drugs were given at 8 ml/h immediately after the initial dose.PIEB regimens were programmed as 8 ml over 80 s once an h after the initial bolus,and the administration was stopped after delivery of fetus.The labor time,consumption of analgesia solution and the incidence of postpartum urinary retention were recorded.Results Compared with group CEI,the duration of the second stage of labor was significantly shortened,and consumption of analgesia solution and the incidence of postpartum urinary retention were decreased in group PIEB(P<0.05).Conclusion Compared with the continuous epidural infusion,the application of PIEB in labor analgesia can reduce the incidence of postpartum urinary retention in nulliparous parturients.