腰硬联合阻滞、硬脊膜穿破硬膜外阻滞及单纯硬膜外阻滞在初产妇分娩镇痛中应用效果的比较

Comparison of the effect of combined spinal-epidural block, dural puncture epidural block and simple epidural block in labor analgesia for primiparae

目的 探究腰硬联合阻滞(CSE)、硬脊膜穿破硬膜外阻滞(DPE)及单纯硬膜外阻滞(EP)在初产妇分娩镇痛中的应用效果。方法 选取2019年9月至2020年9月期间于河北省秦皇岛市妇幼保健院分娩的150例初产妇作为研究对象,随机分为EP组(n=42)、CSE组(n=46)和DPE组(n=48)。比较三组产妇的镇痛效果、分娩相关指标、新生儿健康情况及不良反应。结果 EP组、CSE组T1、T2视觉模拟评分法(VAS)评分呈下降趋势,但T3 VAS有所回升;DPE组T1、T2、T3 VAS呈逐渐下降趋势,且各时点VAS均低于EP组、CSE组(P<0.05)。CSE组、DPE组使用催产素情况、镇痛泵(PCA)次数、舒芬太尼总量、罗哌卡因总量少于EP组(P<0.05),首次PCA时间晚于EP组(P<0.05);DPE组使用缩宫素情况、PCA次数、舒芬太尼总量少于CSE组(P<0.05)。DPE组、CSE组脐带血皮质醇水平均低于EP组(P<0.05)。DPE组不良反应总发生率低于EP组(P<0.05)。结论 相对于EP,CSE、DPE镇痛效果更好,可减少药物总量和PCA次数,并延长首次PCA时间,但DPE效果更显著,且安全性更好。

Objective To investigate the effects of combined spinal-epidural block(CSE), dural puncture epidural(DPE) block and simple epidural block(EP) in labor analgesia for primiparae. Methods A total of 150 primiparae who gave birth in Qinhuangdao Municipal Maternal and Child Health Care Hospital, Hebei Province from September 2019 to September 2020 were selected as the research subjects, and randomly divided into EP group(n=42), CSE group(n=46) and DPE group(n=48). The analgesic effect, delivery-related indicators, neonatal health, and adverse reactions of the three groups were compared. Results The visual analogue scale(VAS) scores of EP group and CSE group decreased at T1 and T2, and increased at T3. The VAS scores of DPE group showed a decreasing trend at T1, T2 and T3, and the scores at different time points were lower than those of EP group and CSE group(P<0.05). The use frequencies of oxytocin and patient-controlled analgesia(PCA) pump, the total dosages of sufentanil and ropivacaine in CES group and DPE group were lower than those in EP group(P<0.05), and the first PCA time was later than that in EP group(P<0.05). The use frequencies of oxytocin and PCA pump, and the total dosage of sufentanil in DPE group were lower than those in CSE group(P<0.05). Umbilical cord blood cortisol levels in DPE group and CSE group were lower than that in EP group(P<0.05). The total incidence of adverse reactions in DPE group was lower than that in EP group(P<0.05). Conclusions Compared with EP, CSE and DPE have better analgesic effects, which can reduce the total dosage of drugs and the use frequency of PCA, and extend the time to the first PCA. However, DPE is more effective and safer.