超声引导硬膜外导管个体化长度置管用于分娩镇痛效果观察

王广龙; 张从利; 殷凤伟; 张运淳

doi:10.16766/j.cnki.issn.1674-4152.002490

超声引导硬膜外导管个体化长度置管用于分娩镇痛效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002490

蚌埠医学院第一附属医院麻醉科，安徽蚌埠 233004

基金项目:

安徽省教育厅自然科学重点项目 KJ2020A0581

详细信息

通讯作者:
张运淳, E-mail: mzycz@126.com

中图分类号: R714.3R614.42
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出版历程
- 收稿日期: 2022-01-18
- 网络出版日期: 2022-09-21

Observation on the effect of individualised length of epidural catheter for labour analgesia under ultrasound guidance

Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的观察超声引导硬膜外导管个体化长度置管用于分娩镇痛的效果。方法选取2019年10月—2020年12月于蚌埠医学院第一附属医院产科行分娩镇痛的100例产妇。采用随机数字表法分为常规组和超声组，每组50例。常规组硬膜外导管置入4 cm, 超声组硬膜外导管置入L₂椎体长度。记录2组硬膜外注药后15 min麻醉平面阻滞范围; 泵运行后30、60、90 min VAS评分；导管不良反应；局麻药用量；泵按压次数；产妇分娩方式；新生儿1 min、2 min Apgar评分；产妇不良反应。结果超声组麻醉平面阻滞范围为(5.24±1.89)个节段，高于常规组的(4.26±1.86)个节段(P < 0.05);超声组泵运行后30、60、90 min VAS评分为(4.38±1.74)分、(3.52±1.92)分、(3.28±1.88)分，均低于常规组的(5.50±2.10)分、(4.46±1.98)分、(4.30±1.91)分(均P < 0.05)；超声组导管不良反应、局麻药用量、泵按压次数分别为10.0%、(21.96±12.01)mL、(3.48±1.88)次，均小于常规组的64.0%、(38.14±9.10)mL、(4.38±1.74)次(均P < 0.05), 余指标差异无统计学意义。结论超声引导硬膜外导个体化长度置管用于分娩镇痛能减少局麻药用量，降低导管不良反应，不影响母婴结局，减少泵按压次数，镇痛效果好。
- 超声 /
- 椎体 /
- 分娩镇痛 /
- 长度 /
- 硬膜外导管
Abstract: Objective To observe the effect of individualised length of epidural catheter for labour analgesia under ultrasound guidance. Methods Total 100 obstetric patients who received labour analgesia in the Obstetrics Department of the First Affiliated Hospital of Bengbu Medical College from October 2019 to December 2020 were selected. They were divided into conventional group and ultrasound group by random number table method, with 50 cases in each group. In the conventional group, the epidural catheter was placed 4 cm, and in the ultrasound group, the epidural catheter was placed in the L₂ vertebral body length. The range of anaesthesia plane block at 15 min after epidural injection, VAS score at 30, 60 and 90 min after pump operation, adverse reactions of catheter, local anaesthetic dosage, pump pressing times, maternal delivery mode, neonatal 1 and 2 min Apgar score, and maternal adverse reactions were compared between the two groups. Results The range of anaesthesia plane block in the ultrasound group [(5.24±1.89) segments] was higher than that in the conventional group [(4.26±1.86) segments, P < 0.05]. The 30, 60 and 90 min VAS scores of the ultrasound group [(4.38±1.74) points, (3.52±1.92) points, (3.28±1.88) points] were lower than those of the conventional group [(5.50±2.10) points, (4.46±1.98) points, (4.30±1.91) points], all P < 0.05. The incidence rate of catheter adverse reactions, local anaesthetic dosage and pump pressing times in the ultrasound group [10.0%, (21.96±12.01) mL and (3.48±1.88) times] were lower than those in the conventional group [64.0%, (38.14±9.10) mL and (4.38±1.74) times], all P < 0.05, and other indicators showed no significant difference. Conclusion Ultrasound-guided epidural catheterisation with individualised length for labour analgesia can reduce the dosage of local anaesthesia, adverse reactions of catheter and number of pump compressions, do not affect the outcome of mother and child, and has a good analgesic effect.
- Ultrasound /
- Vertebral body /
- Labour analgesia /
- Length /
- Epidural catheter

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表 1 2组产妇一般资料比较(x±s)

Table 1. Comparison of general data between the two groups(x±s)

组别	例数	年龄(岁)	孕周(周)	宫口(cm)	BMI	总产程(min)
常规组	50	29.22±2.80	38.94±1.53	2.37±0.87	28.76±2.75	505.88±32.14
超声组	50	29.16±2.94	39.14±1.71	2.38±0.92	28.62±2.74	494.48±32.09
t值		0.104	-0.615	-0.089	0.255	1.775
P值		0.917	0.540	0.929	0.800	0.079

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表 2 2组产妇各时点VAS评分及新生儿Apgar评分比较(x±s，分)

Table 2. Comparison of VAS scores and neonatal Apgar scores between the two groups at each time point (x±s, points)

组别	例数	VAS评分				Apgar评分
组别	例数	T0	T1	T2	T3	1 min	2 min
常规组	50	8.10±1.99	5.50±2.10^a	4.46±1.98^a	4.30±1.91^a	8.38±1.18	8.64±1.06
超声组	50	8.08±1.98	4.38±1.74^a	3.52±1.92^a	3.28±1.88^a	8.58±1.21	8.60±1.21
t值		0.050	2.897	2.396	2.663	-0.800	0.175
P值		0.960	0.005	0.018	0.009	0.426	0.861
注：与T0比较, ^aP < 0.05。

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表 3 2组产妇局麻药用量、泵按压次数及麻醉阻滞范围比较(x±s)

Table 3. Comparison of local anesthetic dosage, pump pressure times and anesthesia block range between the two groups(x±s)

组别	例数	局麻药用量(mL)	按压次数(次)	节段数(个)
常规组	50	38.14±9.10	4.38±1.74	4.26±1.86
超声组	50	21.96±12.01	3.48±1.88	5.24±1.89
t值		-7.591	2.474	-2.613
P值		< 0.001	0.015	0.010

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表 4 2组产妇剖宫产率、顺产率、导管不良反应发生率比较[例(%)]

Table 4. Comparison of cesarean section rate, vaginal delivery rate and incidence of catheter adverse reactions between the two groups [cases (%)]

组别	例数	神经刺激征	折痕	出血	单侧阻滞	顺产	剖宫产
常规组	50	9(18.0)	8(16.0)	6(12.0)	9(18.0)	45(90.0)	5(10.0)
超声组	50	1(2.0)	2(4.0)	0	2(4.0)	47(94.0)	3(6.0)
χ²值		7.111	4.000	6.383	5.005	0.543	0.543
P值		0.008	0.046	0.027	0.025	0.715	0.715

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