程序性间歇硬膜外推注联合硬膜外PCA对产妇产程、爆发痛和发热的影响

Effects of programmed intermittent epidural bolus injection combined with epidural PCA on labor process,breakthrough pain and maternal fever during labor analgesia

目的观察程序性间歇硬膜外推注(PIEB)联合硬膜外患者自控镇痛(PCA)在分娩镇痛中对产妇产程、爆发痛和发热的影响。方法实施分娩镇痛的经阴道分娩产妇60例随机分为两组,每组30例。硬膜外镇痛药液为0.1%罗哌卡因(含芬太尼2μg/mL)。两组在以同样速率推注0.1%罗哌卡因10 mL(含芬太尼2μg/mL)后,PIEB组使用自动间歇性推注6 mL/45 min+硬膜外PCA(每次5 mL),连续硬膜外输注(CEI)组使用连续输注6 mL/h+硬膜外PCA(每次5 mL)。比较两组的产程持续时间、爆发痛、运动阻滞、器械助产、产妇发热的发生率及新生儿出生后的Apgar评分。结果与CEI组比较,PIEB组第二产程时间较短(P<0.05),而两组第一产程时间、第三产程时间、新生儿1-min Apgar评分和5-min Apgar评分比较无统计学差异(P>0.05)。与CEI组比较,PIEB组爆发痛、发热、运动阻滞及器械助产的发生率较低(P<0.05),而两组中转剖宫产及产妇满意率比较差异无统计学意义(P>0.05)。结论PIEB联合硬膜外PCA用于硬膜外分娩镇痛可减少产妇运动阻滞的发生,缩短第二产程时间,并降低产妇爆发痛和发热的风险。

Objective To observe the effects of programmed intermittent epidural bolus injection(PIEB)combined with epidural patient-controlled analgesia(PCA)on labor process,breakthrough pain and maternal fever during labor analgesia.Methods Sixty women undergoing vaginal delivery and receiving epidural labor analgesia were randomly divided into two groups with 30 cases each.The epidural analgesic solution was 0.1%ropivacaine(containing fentanyl 2μg/mL).After epidural bolus injection of 0.1%ropivacaine 10 mL(containing fentanyl 2μg/mL),PIEB group received automatic PIEB injection of 6 mL/45 min plus epidural PCA(5 mL each time),and CEI group received continuous epidural infusion of 6 mL/h plus epidural PCA(5 mL each time).The labor process,breakthrough pain,motor block,instrumental delivery,incidence of maternal fever and Apgar score after delivery were compared between the two groups.Results Compared with CEI group,the second stage of labor was shorter in PIEB group(P<0.05),but there were no significant differences in the first and third stage of labor,1-min Apgar score and 5-min Apgar score between the two groups(P>0.05).Compared with CEI group,the incidence of breakthrough pain,fever,motor block and instrumental assisted delivery was lower in PIEB group(P<0.05).There was no significant difference in maternal satisfaction and transit Cesarean section between the two groups(P>0.05).Conclusion PIEB combined with epidural PCA for epidural labor analgesia can reduce the occurrence of motor blocks,shorten the second stage of labor,and reduce the risk of maternal flareups of pain and fever.