硬膜外间歇脉冲注入技术在肥胖产妇分娩镇痛中对爆发痛的抑制和母婴安全的影响

Effect of programmed intermittent epidural bolus technique on burst pain suppression and the safety of maternal and infant labour analgesia in obese parturients

目的通过观察肥胖产妇腰硬联合分娩镇痛中应用硬膜外间歇脉冲注入技术(PIEB)后的分娩疼痛、爆发痛发生率、分娩相关情况,探讨PIEB在肥胖产妇腰硬联合分娩镇痛中的有效性与安全性。方法选择2020年4月-2021年8月铜陵市妇幼保健院临产足月单胎初产妇100例,采用随机数字法分为PIEB组和连续硬膜外输注(CEI)组,每组50例。比较2组分娩镇痛前后不同时间点的VAS评分、爆发痛情况、镇痛药用量、产程和分娩相关情况、不良反应和产妇满意度。结果最终PIEB组44例,CEI组42例纳入研究。VAS评分的组间、各时点间比较、组别与时间的交互作用均有统计学意义(均P<0.05)。PIEB组爆发痛发生率较CEI组低[27.3%(12/44)vs.50.0%(21/42)],首发时间延迟[(281.27±77.88)min vs.(201.20±48.26)min],患者自控镇痛(PCA)按压次数减少[(1.46±0.65)次vs.(2.29±1.15)次],PCA>1次占比更低[15.9%(7/44)vs.38.1%(16/42)],单位时间麻药用量较少[(8.32±1.60)mg/h vs.(9.12±2.01)mg/h],侧切发生率更低[13.6%(6/44)vs.33.3%(14/42)],但使用缩宫素例数增多[52.3%(23/44)vs.30.9%(13/42)],差异均有统计学意义(均P<0.05)。结论PIEB用于肥胖产妇腰硬联合分娩镇痛可减少爆发痛,延迟爆发痛出现时间,减少麻药用量,母婴安全性高。

Objective To evaluate the efficacy and safety of programmed intermittent epidural bolus(PIEB)in combined lumbar and epidural labour analgesia in obese parturients,by observing the incidence of labour pain,expulsion pain and related conditions after PIEB was applied in the analgesia of combined lumbar and epidural labour in obese parturients.Methods A total of 100 full-term singleton primigravida in Tongling Maternal and Child Health Hospital from April 2020 to August 2021 were randomly divided into PIEB group and continuous epidural infusion(CEI)group by random number method,with 50 cases in each group.Pain VAS scores at various time points before and after labour analgesia,pain onset,analgesic dosage,labour and delivery related conditions,adverse effects and maternal satisfaction were compared between the two groups.Results Finally,44 cases in PIEB group and 42 cases in CEI group were included in the study.The comparison of pain VAS scores between groups,comparison between time points and the interaction between group and time were all statistically significant(all P<0.05).The incidence of pain onset was lower in the PIEB group than in the CEI group[27.3%(12/44)vs.50.0%(21/42)],the onset time was delayed[(281.27±77.88)min vs.(201.20±48.26)min],the number of PCA compressions was reduced[(1.46±0.65)times vs.(2.29±1.15)times],the proportion of PCA>1 time was lower[15.9%(7/44)vs.38.1%(16/42)],the amount of anesthetic per unit time was lower[(8.32±1.60)mg/h vs.(9.12±2.01)mg/h],the incidence of lateral incision was lower[13.6%(6/44)vs.33.3%(14/42)],while the use of oxytocin increased[52.3%(23/44)vs.30.9%(13/42)],and the differences were statistically significant(all P<0.05).Conclusion The application of PIEB used in obese parturients for lumbar and hard labour analgesia can reduce the outbreak of pain,delay the onset of pain,reduce the amount of anaesthesia,with high safety for mother and child.