PIEB对分娩疼痛产间发热及分娩结局的影响

Effects of PIEB on labor pain,intrapartum fever and labor outcomes

目的研究程控硬膜外间歇脉冲注入(PIEB)对分娩疼痛、产间发热及分娩结局的影响。方法前瞻性选择2021年7月至2022年6月沧州市人民医院收治的初产妇200例,依据随机数字表法分为实验组(n=100)与对照组(n=100)。对照组行持续硬膜外输注(CEI)镇痛,实验组行PIEB镇痛。记录并比较两组镇痛前(t_(0))、镇痛后1 h(t_(1))、2 h(t_(2))及宫口开全时(t_(3))的疼痛情况;整个产程中两组罗哌卡因、舒芬太尼用量;镇痛前(t_(0))、胎儿娩出即刻(t_(4))及分娩后2 h(t_(5))白细胞介素(IL)-1β、IL-6及肿瘤坏死因子-α(TNF-α)等炎症因子水平及鼓膜温度;各产程时间、产后出血、器械助产、会阴侧切等分娩情况;新生儿1、5 min Apgar评分。结果t_(0)、t_(1)时,两组VAS评分比较,差异均无统计学意义(P>0.05);t_(2)、t_(3)时,实验组VAS评分均小于对照组,差异均有统计学意义(P<0.05)。实验组罗哌卡因、舒芬太尼用量均小于对照组,差异均有统计学意义(P<0.05)。t_(4)、t_(5)时,两组血清IL-1β、IL-6、TNF-α水平及鼓膜温度均高于t_(0),且实验组血清IL-1β、IL-6、TNF-α水平及鼓膜温度均低于对照组,差异均有统计学意义(P<0.05)。两组第一产程时间、新生儿1 min Apgar评分、新生儿5 min Apgar评分、产后出血、会阴侧切及器械助产情况比较,差异均无统计学意义(P>0.05);实验组第二、第三产程时间均小于对照组,差异均有统计学意义(P<0.05)。结论与CEI镇痛相比较,PIEB镇痛产妇胎儿娩出即刻及分娩后疼痛程度轻,血清炎症因子水平低,麻醉药物用量少,分娩结局良好。

Objective To study the effects of programmed intermittent epidural bolus(PIEB)on labor pain,intrapartum fever and labor outcome.Methods Two hundreds primiparas who were admitted to Cangzhou People's Hospital from July 2021 to June 2022 were prospective selected and divided into experimental group(n=100)and control group(n=100)according to random number table method.The control group received continuous epidural infusion(CEI)analgesia,and the experimental group received PIEB analgesia.The pain before analgesia(t_(0)),1h(t_(1)),2h(t_(2))after analgesia and the full time opening of uterine orifice(t_(3))were recorded and compared in the two groups.The dosage of ropivacaine and sufentanil in the whole labor process of the two groups;the levels of inflammatory factors such as interleukin(IL)-1β,IL-6 and tumor necrosis factor-α(TNF-α)and tympanum temperature before analgesia(t_(0)),immediately after delivery(t_(4))and 2h after delivery(t_(5));labor duration,postpartum hemorrhage,assisted labor,lateral perineal incision and apgar score of newborns 1,5 min were recorded and compared.Results There were no statistically significant differences in VAS scores between the two groups at t_(0) and t_(1)(P>0.05);at t_(2) and t_(3),VAS scores of the experimental group were lower than those of the control group,the differences were statistically significant(P<0.05).The dosage of ropivacaine and sufentanil in experimental group was lower than that in control group,the differences were statistically significant(P<0.05).At t_(4) and t_(5),serum levels of IL-1β,IL-6,TNF-α and tympanic membrane temperature in 2 groups were higher than those at t_(0),and serum levels of IL-1β,IL-6,TNF-α and tympanic membrane temperature at t_(5) were lower than those at t_(4),the differences were statistically significant(P<0.05).There were no statistically significant differences in the first stage of labor,1 min Apgar score of newborn,5 min Apgar score of newborn,postpartum hemorrhage,lateral perineal resection and instrumental delivery between the two groups(P>0.05);the second and third stages of labor in the experimental group were shorter than those in the control group,the differences were statistically significant(P<0.05).Conclusion Compared with CEI analgesia,PIEB analgesia can reduce the pain of the fetus immediately after delivery and after delivery,lower the level of serum inflammatory factors,less amount of narcotic drugs,and a good outcome of delivery.