DPE联合PIEB在分娩镇痛中的应用效果

Application Effect of DPE Combined with PIEB in Labor Analgesia

目的:探讨穿破硬脊膜连续硬膜外阻滞(dural puncture epidural,DPE)联合程控间歇脉冲注入技术(programmed intermittent epidural bolus,PIEB)用于分娩镇痛的效果。方法:选取2021年1-10月福清市医院产科分娩的180例孕妇作为观察对象。按照随机数字表法将其分为A组和B组,各90例。两组在入院后均接受生命体征监测,A组给予硬膜外阻滞(epidural block,EB)联合PIEB,B组给予DPE联合PIEB。比较两组分娩情况,镇痛效果,镇痛前(T)、镇痛后15 min(T)、镇痛后30 min(T)、镇痛后60 min(T)、镇痛后120 min(T)、宫口全开时(T)、胎儿娩出时(T)疼痛情况,罗哌卡因(R)用量,并发症,产程及新生儿情况。结果:两组自然分娩率比较差异无统计学意义(P>0.05)。B组镇痛起效时间及达疼痛数字评价量表(NRS)≤1分时间均短于A组,镇痛泵按压次数少于A组,R补救镇痛率低于A组(P<0.05)。T时两组NRS评分比较差异无统计学意义(P>0.05),T、T、T时B组NRS评分明显低于A组(P<0.05)。B组R每小时用量及总用量均少于A组(P<0.05)。B组并发症发生率低于A组(P<0.05)。两组第一产程和第二产程比较差异均无统计学意义(P>0.05)。两组新生儿1、5 min Apgar评分≤7分占比比较差异均无统计学意义(P>0.05)。结论:EB或DPE联合PIEB用于产科分娩镇痛,对产妇分娩情况和新生儿安全的影响相同,但DPE联合PIEB能够减轻镇痛后15~60 min的疼痛,起效时间更短,镇痛效果更好,进而减少镇痛泵按压次数,降低补救镇痛率,减少R的用量。

Objective:To investigate the effect of dural puncture epidural (DPE) combined with programmed intermittent epidural bolus (PIEB) in the application of labor analgesia.Method:A total of 180 pregnant women who gave birth in the Obstetrics Department of Fuqing Hospital from January to October 2021 were selected as the observation objects.They were divided into group A and group B according to the random number table method,with 90 cases in each group.Both groups received vital signs monitoring after admission.Group A was given the epidural block (EB) combined with PIEB,and group B was given the DPE combined with PIEB.The delivery conditions,analgesia effect,pain condition before analgesia (T),15 min after analgesia (T),30 min after analgesia (T),60 min after analgesia (T),120 min after analgesia (T),at the uterine orifice was fully opened (T),at the fetus was delivered (T),Ropivacaine (R) dosage,complications,labor process and neonatal conditions were compared between the two groups.Result:There was no significant difference in the natural delivery rate between the two groups (P>0.05).The onset time of analgesia and the time to reach a numerical rating scale (NRS) ≤1 point in group B were shorter than those in group A,the times of pressing analgesia pump was less than that in group A,and the rate of R rescue analgesia was lower than that in group A (P<0.05).There was no significant difference in NRS score between the two groups at T(P>0.05),and NRS scores of group B were significantly lower than those of group A at T,Tand T(P<0.05).The hourly dosage and total dosage of R in group B were less than those in group A (P<0.05).The incidence of complication of group B was lower than that of group A (P<0.05).There were no significant differences in the first stage of labor and the second stage of labor between the two groups (P>0.05).There were no significant differences in the proportions of Apgar score ≤7 points at 1 and 5 min between the two groups newborn (P>0.05).Conclusion:EB or DPE combined with PIEB in the application obstetric delivery analgesia has the same impact on the delivery condition of the parturient and the safety of the newborn.However,DPE combined with PIEB can reduce the pain within 15-60 minutes after analgesia,with shorter onset time and better analgesia effect,thus reducing the times of pressing of analgesia pump,reducing the rate of rescue analgesia and reducing the dosage of R.