超声引导硬膜外穿刺不同置管长度用于分娩镇痛的效果

Effect of ultrasonic-guided epidural puncture with different catheterization lengths on labor analgesia

目的 探讨超声实时引导硬膜外穿刺不同置管长度用于分娩镇痛的效果。方法 将2019年12月至2020年11月该院产科100例足月产妇分为A、B、C、D 4组,每组25例,均行无痛分娩。在产妇宫口扩张2~3cm时经L2~3椎间隙行硬膜外穿刺,分别行常规置管4cm,超声实时引导下置管5、4、3cm,加固导管和脉冲镇痛泵相连,药物配置及运行方式均一致。观察硬膜外注药后15min最高冷感觉消失平面及平面上升的节段数、产程时长、硬膜外注药前(t0)止痛泵运行后10、20min,1h的VAS评分,硬膜外置管和拔管操作中,异感和折痕的发生率,新生儿1、3min Apgar评分及产妇不良反应。结果 硬膜外注药后15min最高冷感觉消失平面,B、C组高于A组,D组低于A、B、C组,差异均有统计学意义(P<0.05)。平面上升的节段数D组低于A、B、C组,差异有统计学意义(P<0.05)。注药后4组产妇的VAS评分低于注药前,且泵运行后A组产妇各时点VAS评分显著高于B、C、D组,A组第一、二产程最长,D组第一、二产程最短,差异均有统计学意义(P<0.05)。B、C、D组的异感、折痕发生率低于A组,差异均有统计学意义(P<0.05)。4组不良反应及新生儿出生后1、3min的Apgar评分比较,差异均无统计学意义(P>0.05)。结论 超声引导下置管长度为3cm用于分娩镇痛,麻醉平面适宜,局麻药扩散均匀,能显著减轻产程疼痛,大大缩短产程,还可使放置硬膜外导管过程中孕妇异感、折痕发生率明显降低,母婴结局无不良影响,孕妇呼吸循环平稳。

Objective To investigate the effect of ultrasonic-guided epidural puncture with different catheterization lengths on labor analgesia.Methods A total of 100 full-term parturients from December 2019 to November 2020 were divided into four groups:group A,B,C and D,with 25 cases in each group.All four groups were given painless labor.The epidural puncture was performed through L 2-3 intervertebral space during 2-3 cm dilatation of uterine orifice,routine catheterization was performed for 4 cm,and real-time ultrasound-guided catheterization was performed for 5,4,3 cm.The reinforcing catheter was connected with the pulse analgesia pump,while the drug configuration and operation mode was consistent.The level of the disappearance of the highest cold sensation and the number of ascending segments 15 min after epidural injection,labor course,VAS score 10,20 min,1 h after operation of the analgesic pump and before epidural injection(t 0),the incidence rates of abnormal sensation and crease during epidural catheterization and extubation,neonatal Apgar score at 1,3 min,and maternal adverse reactions were observed.Results Fifteen after epidural injection,the level of the disappearance of the highest cold sensation in group B and C was higher than that in group A,group D was lower than that in group A,B and C,the differences were statistically significant(P<0.05).And the number of ascending segments in group D was lower than that in group A,B and C,the differences were statistically significant(P<0.05).The VAS scores of the four groups after injection were lower than that before injection(P<0.05),and the VSA score of group A was significantly higher than that of group B,C and D after pump operation(P<0.05).The first and second stages of labor were the longest in group A,and the shortest in group D,the differences were statistically significant(P<0.05).The incidence rates of abnormal sensation and crease in group B,C and D were lower than those in group A,the differences were statistically significant(P<0.05).There were no significant differences in the adverse reactions and neonatal Apgar scores at 1,3 min in the four groups(P>0.05).Conclusion Ultrasound-guided catheterization for 3 cm on labor analgesia,anesthesia plane is appropriate,local anesthetics spread evenly,can significantly reduce labor pain,greatly shorten the labor course.It can reduce the incidence rates of abnormal sensation and crease in pregnant women during the process of placing epidural catheters,with no adverse effects on maternal and infant outcomes and stable respiratory circulation in pregnant women.