硬膜穿孔后硬膜外联合程控硬膜外间歇脉冲注入在分娩镇痛中的应用

目的探讨硬膜穿孔后硬膜外（dural puncture epidural，DPE）镇痛联合程控硬膜外间歇脉冲注入（programmed intermittent epidural bolus，PIEB）在分娩镇痛中的安全性和有效性。方法选择自愿接受分娩镇痛的单胎足月初产妇60名，随机分为单纯硬膜外（continuous epidural analgesia，CEA）联合PIEB分娩镇痛组（A组）和DPE联合PIEB分娩镇痛组（B组）。A组产妇实施硬膜外穿刺置管。B组在硬膜外穿刺成功后放入25G腰麻穿刺针，以发现脑脊液回流为准，不注药，行硬膜外置管，药物配方及PIEB设置2组相同。记录镇痛前（T₀）、镇痛后5 min（T₁）、镇痛后10 min（T₂）、镇痛后15 min（T₃）、镇痛后20 min（T₄）、镇痛后1 h（T₅）、宫口开全（T₆）和胎儿娩出（T₇）时的视觉模拟评分法（visual analogue scale，VAS）评分和运动阻滞情况；记录各组自控镇痛（patient controlled epidur alanalgesia，PCEA）次数、舒芬太尼的用量、镇痛不良反应、产程及分娩方式结果、产妇满意度。结果所有产妇均成功实施了分娩镇痛，产程中2组产妇的生命体征（血压、心率、血氧饱和度、呼吸频率）和胎心率平稳，无明显变化（P>0.05）。2组产妇T₁~T₇时间点的VAS评分较T₀降低（P < 0.05），B组T₁~T₄的VAS评分低于A组（P < 0.05）。2组新生儿Apgar评分、产程、分娩方式差异无统计学意义（P>0.05）。B组产妇按压镇痛泵的次数、镇痛药物用量少于A组（P < 0.05）。B组产妇满意度高于A组（P < 0.05）。2组产妇术后改良Bromage差异无统计学意义（P>0.05），术后2组并发症发生差异无统计学意义（P>0.05）。结论DPE联合PIEB是安全、有效的镇痛方法，可用于分娩镇痛。

The application value of DPE combined with PIEB in labor analgesia after epidural perforation

ObjectiveTo investigate the safety and effectiveness of dural puncture epidural(DPE) analgesia combined with programmed epidural intermittent pulse injection(PIEB) in labor analgesia after epidural perforation.MethodsSixty parturient women were randomly divided into group A[treatment with continuous epidural analgesia(CEA) combined with PIEB] and group B(treatment with DPE combined with PIEB).The group A were treated with epidural puncture and catheterization.After successful epidural puncture, the 25G lumbar anesthetic needle was placed in group B, and the epidural tube was placed without injection after cerebrospinal fluid reflux was found.The drug formulation and PIEB settings in group B were the same as the group A.The visual analogue scale(VAS) scores and motor block in two groups before analgesia(T₀), after 5 minutes, 10 minutes, 15 minutes, 20 minutes and 1 hour of analgesia(T₁, T₂, T₃, T₄ and T₅, respectively), full cervical dilation(T₆) and during delivery of fetus(T₇) were recorded.The controlled epidur alanalgesia(PCEA) frequency, dosage of analgesic drug, analgesic adverse reactions, labor process, delivery results and maternal satisfaction were recorded in two groups.ResultsThe labor analgesian in all parturient women were successfully performed, and the vital signs(including blood pressure, heart rate, pulse oxygen saturation and respiratory rate) and fetal heart rate in two groups were stable during the labor process(P>0.05).The VAS scores in two groups at T₁ to T₇ time points were significantly lower than at T0(P < 0.05), and the VAS scores in group B at T₁ to T₄ were significantly lower than those in group A(P < 0.05).There was no statistical significance in Apgar score, labor process and delivery method between two groups(P>0.05).The number of times of pressing analgesic pump and dosage of analgesics in group B were significantly less than those in group A(P < 0.05).The maternal satisfaction in group A was significantly higher than that in group B(P < 0.05).There was no statistical significance in postoperative modified Bromage between two groups(P>0.05), and there was no statistical significance in postoperative complications between two groups(P>0.05).ConclusionsDPE combined with PIEB is a safe and effective method of analgesia, and which can be used for labor analgesia.