程控硬膜外间隙脉冲注入技术在无痛分娩中的应用研究

Study on application of program-controlled epidural space pulse injection technique in painless labor

目的分析程控硬膜外间隙脉冲注入技术(programmed intermittent epidural bolus,PIEB)在无痛分娩中应用价值。方法选取2021年1月—2021年12月郑州市妇幼保健院接诊的106例产科行无痛分娩孕妇,均采取舒芬太尼联合低浓度罗哌卡因镇痛,根据随机数字表法分为两组,每组53例,对照组采用持续硬膜外输注技术镇痛,观察组采用程控硬膜外间隙脉冲注入技术,比较两组产科分娩孕妇的分娩结局、不同时刻的疼痛情况、不良反应、应激指标[血清醛固酮(aldosterone,ALD)、去甲肾上腺素(norepinephrine,NA)]及新生儿情况。结果观察组剖宫产、阴道助产率均为5.67%,均低于对照组的18.87%和30.19%,自然分娩率88.68%高于对照组50.94%(P<0.05);2组镇痛前的VAS评分比较差异无统计学意义(P>0.05)。观察组用药后30 min、宫口全开时、胎儿娩出时的VAS评分分别为(1.57±0.31)分、(1.71±0.26)分、(1.77±0.49)分,均低于对照组,差异有统计学意义(P<0.05);观察组尿潴留、低血压、瘙痒、呕吐、恶心等不良反应发生率5.00%,低于对照组30.00%,差异有统计学意义(P<0.05);2组宫口开至3cm时的醛固酮、去甲肾上腺素水平比较(P>0.05)。观察组胎儿娩出时的醛固酮、去甲肾上腺素水平是(111.76±21.46)ng/L及(390.67±49.76)ng/L,均低于对照组,差异有统计学意义(P<0.05);观察组新生儿1分钟Apgar评分、5分钟Apgar评分是(9.49±0.28)分和(9.81±0.11)分,均高于对照组,差异有统计学意义(P<0.05)。结论程控硬膜外间隙脉冲注入技术在分娩镇痛中具有显著效果,可以有效地缓解患者的疼痛感,降低患者的不良反应,值得在临床中推广使用。

Objective To analyze application value of programmed intermittent epidural bolus(PIEB)in labor analgesia.Methods A total of 106 obstetric women who underwent painless labor and were admitted to Zhengzhou Maternal and Child Health Hospital from January 2021 to December 2021 were selected,all of whom received sufentanil combined with low-concentration ropivacaine for analgesia.According to random number table method they were divided into two groups,each group 53 cases.The control group received continuous epidural infusion for analgesia,and the observation group received program-controlled epidural space pulse injection.Delivery outcomes,pain at different times,adverse reactions,stress indices[serum aldosterone(ALD),norepinephrine(NA)]and neonatal conditions were compared between two groups.Results The group observation rate of natural delivery was 88.68%higher than that of control group 50.94%,vaginal midwifery and cesarean section rate of observation group were 5.67%,both lower than taht of control group(P<0.05).There was no statistical difference in VAS scores before analgesia between 2 groups(P>0.05).The VAS scores of observation in group 30 min after treatment,at full uterine opening and fetal delivery were(1.57±0.31),(1.71±0.26)and(1.77±0.49),respectively,all lower than control group(P<0.05).The nausea,vomiting,pruritus,hypotension and urinary retention of adverse reactions incidence in observation group was 5.00%,lower than control group and the difference was statistically significant(30.00%,P<0.05).The levels of aldosterone and norepinephrine in 2 groups were compared when the uterine opening was 3cm(P>0.05).The levels of aldosterone and norepinephrine at delivery in the observation group were(111.76±21.46)ng/L and(390.67±49.76)ng/L,which were lower than those in the control group(P<0.05).The 1-minute Apgar score and 5-minute Apgar score in the observation group were(9.49±0.28)and(9.81±0.11),which were higher than those in the control group(P<0.05).Conclusion Program-controlled epidural space pulse injection technique has a remarkable effect in labor analgesia,whhich can effectively relieve the pain of patients,reduce the adverse reactions of patients,and is worthy of clinical application.