规律间断与持续硬膜外注射对分娩镇痛产妇运动功能及分娩结果的影响比较

发布时间：2018-05-15 16:47

本文选题：腰-硬联合阻滞 + 分娩镇痛　；参考：《广东医学》2017年03期

【摘要】：目的评价规律间断给药和持续注射用于腰-硬联合阻滞分娩镇痛对产妇运动功能及分娩结果的影响。方法选择行腰-硬联合阻滞分娩镇痛的产妇155例,随机分为两组:规律间断硬膜外注射组(RIEB组)80例,蛛网膜下腔注射注入1 m L溶液(舒芬太尼5μg/m L+0.2%罗哌卡因),然后每小时给予硬膜外单次注射6m L(舒芬太尼0.25μg/m L+0.08%罗哌卡因);持续给药组(CEI组)75例,给予上述腰麻药量后,按6 m L/h速度持续硬膜外给药。主要观测指标为产妇运动神经阻滞发生率、器械辅助分娩率及剖宫产率。镇痛开始后,每小时用视觉模拟评分法(VAS)评估疼痛程度,用改良Bromage评分法评价下肢运动神经阻滞情况,同时记录产程时间、镇痛时间、罗哌卡因总量、舒芬太尼总量、需PCA产妇数及每例产妇PCA次数及新生儿Apgar评分。结果与RIEB组比较,CEI组在镇痛2~10 h期间,下肢运动神经阻滞发生率、器械辅助分娩率及剖宫产率均显著增高(P0.01),且罗哌卡因用量、舒芬太尼用量、需PCA产妇数及每例产妇PCA次数明显增加(P0.01);两组产程时间、镇痛时间、第一产程VAS评分及新生儿Apgar评分差异无统计学意义。结论规律间断给药与持续注射用于腰-硬联合阻滞分娩镇痛,前者不但可以降低运动神经阻滞发生率,而且还可以降低产妇器械辅助分娩率及剖宫产率。
[Abstract]:Objective to evaluate the effects of regular intermittent administration and continuous injection on the motor function and delivery outcome of parturient after combined spinal-epidural block analgesia. Methods 155 parturients undergoing combined spinal-epidural block analgesia were randomly divided into two groups: the regular intermittent epidural injection group (RIEB group, n = 80), and the control group (n = 80). Subarachnoid injection of 1 mL solution (sufentanil 5 渭 g / mL 0.2% ropivacaine per hour) was followed by a single epidural injection of 6 mL (sufentanil 0.25 渭 g / mL 0.08% ropivacaine per hour). Continuous epidural administration at the rate of 6 mL / h. Main outcome measures: incidence of motor nerve block, assisted delivery rate and cesarean section rate. After the analgesia began, the pain degree was assessed by visual analogue scale (VAS), the motor nerve block of lower extremity was evaluated by modified Bromage score, and the time of labor, analgesia, total amount of ropivacaine and total sufentanil were recorded at the time of labor, analgesia, total amount of ropivacaine and total amount of sufentanil. The number of PCA puerpera, the number of PCA per parturient and the neonatal Apgar score were required. Results compared with RIEB group, the incidence of motor nerve block, the rate of assisted delivery and the rate of cesarean section were significantly higher in the control group than in the RIEB group, and the dosage of ropivacaine and sufentanil were significantly higher than those in the control group. The number of parturient who needed PCA and the number of PCA per parturient increased significantly (P 0.01), but there was no significant difference between the two groups in the time of labor, analgesic time, VAS score of the first stage of labor and Apgar score of newborn. Conclusion regular intermittent administration and continuous injection can not only reduce the incidence of motor nerve block, but also reduce the rate of assisted parturition and cesarean section.
【作者单位】：广州医科大学附属第二医院麻醉科;广州医科大学附属第二医院产科二区;南方医科大学珠江医院麻醉科;
【分类号】：R714.3

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