硬膜外程控间歇脉冲式联合PCEA在分娩镇痛中的应用效果及对产妇运动神经阻滞程度的影响

Effect of epidural programmed intermittent pulse combined with PCEA in labor analgesia and its influence on the degree of motor nerve block in parturients

目的探究硬膜外程控间歇脉冲式联合硬膜外自控镇痛(PCEA)在分娩镇痛中应用效果及对产妇运动神经阻滞程度的影响。方法采用前瞻性研究,选择2019年7月至2022年3月沧州市人民医院收治待分娩产妇82例为研究对象,以随机数字表法行分组处理,对照组、观察组每组各41例。对照组接受连续硬膜外注入联合PCEA镇痛,观察组以硬膜外程控间歇脉冲式联合PCEA镇痛。比较两组镇痛前、镇静后10 min(T1)、镇静后30 min(T2)、麻醉后1 h(T3)、分娩时(T4)的疼痛视觉模拟评分法(VAS)评分、SpO_(2)和呼吸频率,并统计两组产妇的运动神经阻滞程度、不良反应发生情况。结果观察组T1、T2、T3、T4时段VAS评分为(4.33±0.67)、(1.89±0.34)、(1.60±0.31)、(1.77±0.38)分,均较对照组[(4.91±0.50)、(2.40±0.42)、(2.77±0.39)、(3.80±0.44)分]降低,差异均有统计学意义(P<0.05)。观察组T1、T2、T3、T4时段SpO_(2)为(97.24±1.15)%、(97.88±1.13)%、(97.62±1.17)%、(97.59±1.13)%,均较对照组[(93.83±1.08)%、(93.05±1.05)%、(93.11±1.08)%、(94.30±1.01)%]高,观察组T1、T2、T3、T4时段呼吸频率为(20.05±1.13)、(20.37±1.12)、(20.55±1.09)、(21.45±1.17)次/min,均较对照组[(18.16±1.15)、(17.80±1.09)、(17.90±1.04)、(18.40±1.10)次/min]高,差异均有统计学意义(P<0.05)。观察组分娩1 h后Bromage评分为(1.03±0.10)分,较对照组[(1.03±0.10)分]低,且观察组运动恢复时间为(1.03±0.10)min,较对照组[(180.72±13.80)min]短,差异均有统计学意义(P<0.05)。观察组低血压、寒战、心动过速、高热、呕吐等不良反应发生率为7.32%,较对照组(24.39%)低,差异有统计学意义(P<0.05)。结论硬膜外程控间歇脉冲式联合PCEA用于产妇分娩镇痛中,不仅可缓解疼痛,稳定呼吸循环功能,还能改善产妇运动神经阻滞程度,降低不良反应发生率,值得推广。

Objective To explore the effect of epidural programmed intermittent pulse combined with patient epidural controlled analgesia(PCEA)in labor analgesia and its influence on the degree of motor nerve block of parturients.Methods A prospective study was conducted to select 82 parturients who were admitted to Cangzhou People's Hospital from July 2019 to March 2022 as the study objects.The patients were divided into two groups by random number table.There were 41 cases in each group of the control group and the observation group.The control group received continuous epidural injection combined with PCEA analgesia,and the observation group received epidural programmed intermittent pulse combined with PCEA analgesia.The VAS score,SpO_(2)and respiratory rate before analgesia,10 minutes after sedation(T1),30 minutes after sedation(T2),1 hour after anesthesia(T3),and at delivery(T4)were compared between the two groups,and the degree of motor nerve block and the occurrence of adverse reactions were counted.Results The VAS scores of the observation group in T1,T2,T3 and T4 were(4.33±0.67),(1.89±0.34),(1.60±0.31),(1.77±0.38)points,which were lower than those of the control group[(4.91±0.50),(2.40±0.42),(2.77±0.39),(3.80±0.44)],the differences were statistically significant(P<0.05).In the observation group,SpO_(2)of T1 T1,T2,T3 and T4 were(97.24±1.15)%,(97.88±1.13)%,(97.62±1.17)%,(97.59±1.13)%,which were higher than those in the control group[(93.83±1.08)%,(93.05±1.05)%,(93.11±1.08)%,(94.30±1.01)%],respiratory rate of T1 T1,T2,T3 and T4 in the observation group were(20.05±1.13),(20.37±1.12),(20.55±1.09),(21.45±1.17)times/min,which were higher than those in control group[(18.16±1.15),(17.80±1.09),(17.90±1.04),(18.40±1.10)times/min],the differences were statistically significant(P<0.05).The Bromage scores of the observation group one hour after delivery were(1.03±0.10)points,which were lower than those of the control group[(1.03±0.10)],and the recovery time of the observation group were(1.03±0.10)minutes,which were shorter than those of the control group[(180.72±13.80)minutes],the differences were statistically significant(P<0.05).The incidence of adverse reactions such as hypotension,chills,tachycardia,hyperthermia and vomiting in the observation group was 7.32%,which was lower than that in the control group(24.39%),the difference was statistically significant(P<0.05).Conclusion Epidural programmed intermittent pulse combined with PCEA can not only relieve pain,stabilize respiratory and circulatory functions,but also improve the degree of motor nerve block in parturients,reduce the incidence of adverse reactions,which is worth popularizing.