两种硬膜外阻滞技术对分娩镇痛的效果及母婴结局的影响

Effects of two epidural block techniques on labor analgesia and their impact on maternal and infant outcomes

目的探讨两种硬膜外阻滞技术用于分娩镇痛的效果及其对母婴结局的影响。方法80例接受分娩镇痛的单胎头位初产妇均分为硬膜外阻滞组(EP组)和硬脊膜穿破硬膜外阻滞组(DPE组);硬膜外腔穿刺成功后EP组作硬膜外置管,DPE组用25 G腰麻针刺破硬脊膜至蛛网膜下腔(以脑脊液流出为准)、行硬膜外置管;于镇痛前(T_(0))、镇痛后5 min(T_(1))、10 min(T_(2))、30 min(T_(3))、1 h(T_(4))及宫口开全(T_(5))时,采用视觉模拟评分(VAS)对产妇进行疼痛评估,采用Bromage评分评价运动阻滞程度;比较2组产妇的一般资料、产科和新生儿资料及镇痛资料;于胎儿娩出后采集脐动脉血行动脉血气分析;于镇痛前及分娩后2 h采集产妇唾液,采用酶联免疫吸附法(ELISA)法检测皮质醇浓度。结果与EP组比较,DPE组T_(1)、T_(2)、T_(4)、T_(5)时VAS评分降低,PCA次数、总药量降低,产妇分娩后2 h唾液皮质醇浓度降低(P<0.05);2组产妇结局、新生儿结局以及不良反应发生率比较差异无统计学意义(P>0.05)。结论DPE用于分娩镇痛效果优于EP,药量消耗减少,减轻应激反应,且对产妇和新生儿无不良影响。

Objective To investigate the effect of two epidural block techniques on labor analgesia and theirs impact on maternal and infant outcomes.Methods Eighty single cephalic primiparas who received labor analgesia were divided into epidural group(EP group)and dural puncture epidural block roup(DPE group).EP group received epidural catheterization immediately after successful epidural puncture,while DPE group received a single dural puncture into subarachnoid space with a 25-gauge needle until outflow of cerebrospinal fluid was observed before epidural catheterization.At the following time points before analgesia(T_(0)),at 5 min(T_(1)),10 min(T_(2)),30 min(T_(3)),1 h(T_(4))after analgesia and when the cervix was fully dilated(T_(5)),visual analogue score(VAS)was used to assess analgesia degrees,while Bromage score was used to assess the degree of motor block.The general data,obstetric data and neonatal data and analgesia data were compared between two groups.After delivery,umbilical artery blood was collected to analyze arterial blood gas.Saliva was collected before analgesia and 2 h after delivery to determine cortisol concentration using enzyme-linked immunosorbent assay(ELISA)assay.Results DPE group had lower VAS scores,PCA times and total drug dose than EP group at T_(1),T_(2),T_(4),and T_(5).Salivary cortisol concentration in DPE was reduced at 2 hours after delivery relative to EP group(P<0.05).There were no significant differences in the outcomes of maternal and infant Outcomes as well as the incidence rates of adverse reactions(P>0.05).Conclusion DPE has better efficacy in alleviating labor analgesia than EP.DPE reduces drug consumption and stress response,and has no adverse effects on parturients and newborns.