不同脉冲间隔时间行程控硬膜外脉冲式注射对分娩镇痛的影响

Effect of programmed intermittent epidural bolus at different interval time for labor analgesia

摘要:

目的 观察不同间隔时间行程控硬膜外脉冲式注射（PIEB）和连续硬膜外输注（CEI）对于分娩镇痛效果的影响。方法 选择要求行分娩镇痛的单胎足月顺产初产妇229例，采用数字表法随机分为三组：PIEB模式间隔30 min组（P30组，n＝77）、PIEB模式间隔60 min组（P60组，n＝76）和CEI模式组（C组，n＝76）。产妇侧卧位于L3-4间隙行硬膜外穿刺，均使用首次剂量0.08%罗哌卡因+0.3 μg/mL舒芬太尼混合镇痛液10 mL。P30组给药间隔30 min，单次脉冲剂量5 mL，P60组给药间隔60 min，单次脉冲剂量10 mL，C组10 mL/h恒速输注。镇痛泵配方为 0.08%罗哌卡因+0.3 μg/mL舒芬太尼共150 mL，PCEA量5 mL，锁定时间10 min。观察镇痛前、镇痛后1 h、2 h、3 h、4 h、宫口开全时、分娩时宫缩视觉模拟评分法（VAS）评分和Bromage评分。记录有效自控硬膜外镇痛（PCEA）次数、硬膜外用药总量、产程时间及不良反应的发生情况。结果 三组产妇在分娩镇痛开始后VAS评分均低于镇痛前（P<0.05）。P30组和P60组镇痛后3 h、4 h、宫口开全及分娩时VAS评分低于C组（P<0.05），P60组宫口开全及分娩时VAS评分低于P30组（P<0.05）。P30组和P60组镇痛用药总量和有效PCEA次数低于C组（P<0.05），P60组有效PCEA次数低于P30组（P<0.05）。P60组满意度高于P30和C组（P<0.05）。三组产程时间、Bromage评分、不良反应发生率差异无统计学意义。结论 PIEB用于分娩镇痛可达到更好的镇痛效果，且间隔60 min行PIEB模式注射是一种更理想的给药方法。

Abstract:

Objective To compare the clinical efficacy of programmed intermittent epidural bolus (PIEB) with continuous epidural infusion (CEI) at different interval time for labor analgesia.Methods A total of 229 primiparous full-term singleton pregnant women requiring labor analgesia were randomly divided into three groups: PIEB mode at an interval of 30 min group (group P30, n=77), PIEB mode at an interval of 60 min group (group P60, n=76) and traditional CEI mode group (group C, n=76). Epidural catheters was placed at the L3-4 interspace with the subject in lateral position. Epidural solution was 0.08% ropivacaine and 0.3 μg/mL sufentanil, and the initial loading dose was 10 mL. PIEB regimens were programmed as bolus 5 mL per 30 min starting from 30 min after analgesia began in group P30 and bolus 10 mL per 60 min starting from 60 min after analgesia began in group P60. Group C received continuous infusion at 10 mL/h immediately when analgesia began. The patient-controlled epidural analgesia (PCEA) dose was 5 mL with a 10 minutes lockout. The drugs used in the pump were 0.08% ropivacaine and 0.3 μg/mL sufentanil in three groups. Visual Analog Scale (VAS) scores and modified Bromage scores were recorded before labor analgesia, 1, 2, 3 and 4 hours after labor analgesia, at full dilation of the cervix and during delivery. The consumption of anesthetic, the number of pressing of self-controlled analgesia pump, and occurrence of adverse reactions were recorded.Results The VAS scores obviously decreased in the three groups since receiving labor analgesia (P<0.05). Compared with group C, the VAS scores of group P30 and group P60 were decreased 3 and 4 hours after labor analgesia, at full dilation of the cervix and during delivery (P<0.05). The VAS scores of group P60 at the uterus fully opened and delivery were lower than those in group P30 (P<0.05). The total drug consumption and the number of PCEA were decreased obviously in group P30 and group P60 (P<0.05). The effective frequency of PCEA in group P60 was less than that in group P30 (P<0.05). The analgesia satisfaction in group P60 was higher than that in group P30 and group C (P<0.05). There were no significant differences in the duration of labor, Bromage score, occurrence of adverse reactions among the three groups.Conclusion PIEB provides reliable efficacy for labor analgesia and PIEB injection at an interval time of 60 min is an ideal method.