分娩镇痛应用罗哌卡因剂量预测模型的建立

Establishment of a dose prediction model of ropivacaine in labor analgesia combined with patient-controlled epidural analgesia

目的建立硬膜外自控镇痛(PCEA)中罗哌卡因剂量的预测模型。方法选择2021年1月至2022年4月在扬州大学附属医院行PCEA分娩的初产妇(120例)为研究对象;单盲随机分为ALR组(一元线性回归方程模型)、MLR组(多元线性回归方程模型)和DBN组(人工神经网络模型),每组40例。比较3组产妇的临床资料、镇痛效果、镇痛药物使用情况及满意度。采用Kaplan-Meier方法绘制生存曲线分析3组产妇的总产程时间。结果ALR组、MLR组与DBN组T1时疼痛视觉模拟评分(VAS)、镇痛起效时间、镇痛维持时间、PCEA按压次数、舒芬太尼用量比较差异均有统计学意义(F值分别为2.390、2.402、2.507、2.125、2.361,P<0.05),进一步比较,DBN组T2时疼痛VAS评分、PCEA按压次数均较ALR组更低(P<0.05)。生存曲线结果显示,3组总产程时间比较差异有统计学意义(χ^(2)=6.150,P<0.05);ALR组与DBN组总产程时间比较差异有统计学意义(χ^(2)=6.146,P<0.05)。DBN组满意度为优的产妇比例最高(90.00%),但3组产妇满意度比较差异无统计学意义(χ^(2)=5.032,P>0.05)。结论DBN组、MLR组罗哌卡因剂量在PCEA分娩镇痛中的有效性、满意度均优于ALR组,以DBN组最优。

Objective To establish a dose prediction model of ropivacaine in labor analgesia combined with patient controlled epidural analgesia(PCEA).Methods 120 primiparae who delivered with PCEA in The Affiliated Hospital of Yangzhou University from January 2021 to April 2022 as research subjects,and they were randomly divided into univariate linear regression equation mode group(ALR group),multivariate linear regression equation model group(MLR group),and artificial neural network model group(DBN group)in single-blind method,with 40 cases in each group.The clinical data,analgesic effects,analgesic drug use and satisfaction degree of the parturients were analyzed and compared among the three groups.Kaplan Meier method was used to plot survival curves to analyze the total duration of labor of the parturients in the three groups.Results At T1,there were significant differences in score in pain visual analogue scale(VAS),analgesia onset time,analgesia maintenance time,PCEA compression frequency and dosage of sufentanil among the three groups(all P<0.05).At T1,The parturient women in the DBN group had lower score in pain VAS(F=2.390,P=0.020),shorter analgesia onset time(F=2.402,P=0.019),and longer analgesia maintenance time(F=2.507,P=0.015)and low PCEA compression frequency(F=2.125,P=0.044)and lower dosage of sufentanil(F=2.361,P=0.023),and further comparison shown that the pain VAS score at T2 and PCEA compression frequency in the DBN group were lower than that in the ALR group(F=2.145,P=0.036).The survival curve results showed that there were significant differences in total labor process duration among the three groups(χ^(2)=6.150,P=0.046),and there was a significant difference in total labor process duration between the ALR group and the DBN group(χ^(2)=6.146,P=0.013).The proportion of the parturient women with excellent satisfaction in the DBN group was the highest,but there was no significant difference in the parturients'satisfaction among the three groups(χ^(2)=5.032,P>0.05).Conclusion The effectiveness and satisfaction of ropivacaine dosage in PCEA for labor analgesia are better in the DBN and MLR groups than those in the ALR group,of which,those in the DBN group are the best.