腰硬联合与硬膜外镇痛对产妇产后早期痛觉过敏影响

EFFECT OF COMBINED SPINAL-EPIDURAL ANALGESIA VERSUS EPIDURAL ANALGESIA ON HYPERALGESIA IN PARTURIENTS IN THE EARLY POSTPARTUM PERIOD

目的 评价腰硬联合自控镇痛与硬膜外自控镇痛两种方式用于无痛分娩时对产妇产后早期痛觉过敏的影响。方法 随机选取拒绝进行分娩镇痛的产妇32例(C组)和自愿要求分娩镇痛的产妇64例,再采用随机数字表法将后者分为腰硬联合组(LA组)和硬膜外组(L组)各32例。分娩镇痛的产妇有镇痛需求时行椎管内穿刺置管进行分娩镇痛;C组产妇常规分娩,不予镇痛处理。在不同的时间点记录产妇机械痛觉阈值、视觉模拟评分法(VAS)评分、第一产程及第二产程时长、镇痛泵药物使用总量、胎儿娩出后的Apgar评分。结果 在C组中,与宫缩启动前比较,产后脐下3 cm、腘窝上缘5 cm的机械痛觉阈值下降,差异具有统计学意义(F=28.100、11.893,P<0.05)。与C组比较,LA组产妇产后脐下3 cm的机械痛觉阈值显著增高(F=5.206~95.506,P<0.05),LA组和L组产妇产后腘窝上缘5 cm的机械痛觉阈值显著增高(F=19.051~28.008,P<0.05)、第一产程和第二产程显著延长(F=404.674、289.950,P<0.05)、宫口开全时VAS评分显著降低(F=808.627,P<0.05)。LA组和L组镇痛泵药物使用总量、各组新生儿Apgar评分差异均无统计学意义(P>0.05)。结论 分娩疼痛可诱发痛觉过敏,导致产后痛觉阈值下降。椎管内阻滞分娩镇痛可减轻由分娩疼痛造成的痛觉过敏,腰硬联合镇痛在预防痛觉过敏方面可能比硬膜外镇痛有更大的优势。

Objective To investigate the effect of patient-controlled combined spinal-epidural analgesia versus patient-controlled epidural analgesia during painless delivery on hyperalgesia in parturients in the early postpartum period. Methods A total of 32 parturients who refused labor analgesia(group C) and 64 parturients who voluntarily requested labor analgesia were randomly selected, and then the latter patients were divided into combined spinal-epidural analgesia group(LA group) and epidural analgesia group(L group) using a random number table, with 32 patients in each group. Intraspinal puncture was performed for labor analgesia when the parturients requested analgesia, and the parturients in group C were not given analgesic treatment. Related indicators were recorded at different time points, including mechanical pain threshold, Visual Analogue Scale(VAS) score, duration of the first and second stages of labor, the total amount of drugs used in the analgesic pump, and Apgar score after delivery. ResultsIn group C, there was a significant reduction in mechanical pain threshold at 3 cm below the umbilicus and 5 cm above the popliteal fossa after delivery(F=28.100,11.893;P<0.05). Compared with group C, the LA group had a significant increase in mechanical pain threshold at 3 cm below the umbilicus(F=5.206-95.506,P<0.05), and the LA group and the L group had a significant increase in mechanical pain threshold at 5 cm above the popliteal fossa(F=19.051-28.008,P<0.05), significant prolongation of the first and second stages of labor(F=404.674,289.950;P<0.05), and a significant reduction in VAS score after complete ope-ning of the uterus orifice(F=808.627,P<0.05). There were no significant differences in the total amount of drugs used in the analgesic pump and neonatal Apgar score between the LA group and the L group(P>0.05). Conclusion Labor pain can induce hyperalgesia, resulting in the reduction in pain threshold after delivery. Intraspinal nerve block for labor analgesia can alleviate hype-ralgesia caused by labor pain, and combined spinal-epidural analgesia may have a greater advantage than epidural analgesia in preventing hyperalgesia.