硬膜外程控间歇脉冲式分娩镇痛对产程、产妇及新生儿临床转归的影响

Effect of programmed intermittent epidural bolus in labor analgesia on labor process and maternal and neonatal clinical outcomes

目的 观察硬膜外程控间歇脉冲式分娩镇痛对产程、产妇及新生儿临床转归的影响。方法 回顾性分析2019年6月~2021年3月贵港市人民医院收治的ASAⅠ~Ⅱ级,单胎头位初产妇150例,分为A、B、C三组,每组50例。A组采用非镇痛分娩,B组采用持续背景输注联合硬膜外自控输注,C组采用程控硬膜外间歇脉冲输注联合硬膜外自控输注。比较产妇镇痛后不同时间点(30 min、1 h、2 h、4 h及宫口开全)疼痛评分(VAS评分)、下肢运动能力评分(Bromage评分)、第二产程时间、总产程时间、新生儿Apgar评分、产妇剖宫产率以及使用缩宫素情况。结果 C组与B组在镇痛后30 min、1 h、2 h、4 h及宫口开全时VAS评分、Bromage评分以及使用缩宫素情况比较差异有统计学意义(P<0.05),且两组均明显优于A组(P<0.05)。C组与B组在第二产程时间、总产程时间、剖宫产率方面比较差异无统计学意义(P>0.05),但均少于A组(P<0.05)。在新生儿Apgar评分方面,三组比较差异无统计学意义(P>0.05)。结论 硬膜外程控间歇脉冲式分娩镇痛具有良好的镇痛效果,能有效减轻产妇的疼痛,值得临床推广。

Objective To observe the effect of programmed intermittent epidural bolus in labor analgesia on labor process and maternal and neonatal clinical outcomes. Methods A total of 150 primiparas of ASA Ⅰ-Ⅱ with singletons and head positions admitted to Guigang People’s Hospital from June 2019 to March 2021 were retrospectively analyzed. They were divided into group A, group B and group C, with 50 cases in each group. Non-analgesic delivery was used in the group A, continuous background infusion combined with patient controlled epidural infusion was used in the group B, and programmed intermittent epidural bolus combined with patient controlled epidural infusion was used in the group C. And then, pain score(visual analogue scale/score, VAS) and lower limb motor ability score(Bromage score) at different time points after analgesia(30 min, 1 h, 2 h, 4 h and the time at uterus opened to the full extent), the second stage of labor time, total labor time, Apgar score of newborns, the rate of cesarean section and the use of oxytocin were observed. Results There were statistically significant differences in the VAS scores and Bromage scores at different time points after analgesia(30 min, 1 h, 2 h, 4 h and the time at uterus opened to the full extent), and the use of oxytocin in the group B and the group C(P<0.05), and they were all superior to those in the group A(P<0.05). Difference of the second stage of labor time, total labor time and the rate of cesarean section was not statistically significant between the group C and the group B(P>0.05), but were lower than those in the group A(P<0.05). There was no statistically significant difference in the Apgar scores of newborns among the three groups(P>0.05). Conclusion Programmed intermittent epidural boluse has good analgesic effect on labor analgesia, it can effectively reduce the pain of delivery women, and thus is worthy of clinical promotion.