硬脊膜穿破硬膜外阻滞在妊娠期高血压疾病产妇分娩镇痛中的应用

目的探讨硬脊膜穿破硬膜外阻滞在妊娠期高血压疾病产妇分娩镇痛中的应用。方法回顾性将2017年8月至2018年8月于北京妇产医院就诊收治的158例接受分娩镇痛的妊娠期高血压疾病产妇作为研究对象,根据产妇不同的麻醉方式将其分为腰-硬联合镇痛组(n=52)、自控硬膜外镇痛组(n=54)和硬脊膜穿破复合硬膜外镇痛组(n=52)。于镇痛前、镇痛后1 min、5 min、10 min和60 min行视觉模拟评分法(VAS评分)。记录三组舒芬太尼镇痛用量、病人自控镇痛(PCA)次数和首次PCA时间、镇痛不良反应及分娩方式及产程。结果三组产妇镇痛后1 min、5 min、10 min和60 min VAS评分均明显低于镇痛前(P<0.05);腰-硬联合镇痛组和硬脊膜穿破复合硬膜外镇痛组镇痛后1 min、5 min均明显低于自控硬膜外镇痛组(P<0.05)。硬脊膜穿破复合硬膜外镇痛组和腰-硬联合镇痛组舒芬太尼镇痛用量和PCA次数较自控硬膜外镇痛组明显减少,首次PCA时间明显延长(P<0.05)。硬脊膜穿破复合硬膜外镇痛组较自控硬膜外镇痛组产前发热例数明显减少,第一产程活跃期明显缩短,器械助产例数明显减少(P<0.05);腰-硬联合镇痛组较自控硬膜外镇痛组胎心减慢和瘙痒例数明显增加,第一产程活跃期明显缩短,器械助产例数明显减少(P<0.05)。硬脊膜穿破复合硬膜外镇痛组较腰-硬联合镇痛组产前发热、胎心减慢和瘙痒例数明显减少,剖宫产例数明显减少(P<0.05)。结论硬脊膜穿破硬膜外阻滞在妊娠期高血压产妇分娩镇痛中的应用效果良好,安全性也较高。

Application of dural penetrating epidural block in labor analgesia in pregnant women with hypertensive disorder complicating pregnancy

Objective To investigate the application of dural epidural anesthesia in labor analgesia in patients with hypertensive disorder complicating pregnancy.Methods A total of 158 women who received gestational hypertensive disorder in our hospital from August 2017 to August 2018 were enrolled in the study.According to different anesthesia methods,they were divided into a lumbar-hard joint analgesia group(CSE group)(n=52),epidural analgesia group(EP group)(n=54)and dural perforation combined with epidural analgesia group(DPE group)(n=52).VAS scores were performed before,after analgesia at 1 min,5 min,10 min and 60 min.The analgesic dosage of sufentanil,the frequency of controlled analgesia(PCA),the time of the first PCA,adverse analgesic reactions,delivery mode and labor process of each group were recorded.Results Vas scores at 1 min,5 min,10 min and 60 min after analgesia were significantly lower than those before analgesia(P<0.05).Vas scores at both 1 min and 5 min after analgesia in the combined lumbar-epidural analgesia group and the dural perforation combined epidural analgesia group were significantly lower than those in the controlled epidural analgesia group(P<0.05).The analgesic dosage and PCA frequency of sufentanil in the dural perforation combined epidural analgesia group and the lumbar-epidural analgesia group were significantly reduced compared with those in the controlled epidural analgesia group,and the time of the first PCA was significantly prolonged(P<0.05).The number of prenatal fever cases was significantly reduced,the active period of the first stage of labor was significantly shortened,and the number of device midwifery cases was significantly reduced in the dural puncture combined with epidural analgesia group compared with those in the self-controlled epidural analgesia group,(P<0.05).The number of fetal heart slowing and itching were significantly increased,the active period of the first stage of labor was significantly shortened,and the number of device midwifery cases were significantly reduced in the lumbar-hard combined analgesia group compared with those in the self-controlled epidural analgesia group(P<0.05).The number of cases of prenatal fever,fetal heart slowing,and itching in the the dural perforation combined epidural analgesia group were significantly reduced,and the number of cesarean sections was significantly reduced compared with those in the combined lumbar-epidural analgesia group(P<0.05).Conclusion Dural penetrating epidural block is effective in the treatment of labor analgesia in pregnant women with hypertensive disorder,and the safety is also high.