硬膜外间歇脉冲注入技术在肥胖产妇分娩镇痛中对爆发痛的抑制和母婴安全的影响

蒋嫣; 柯善高; 王芬; 吴媛; 吴焘; 周取升; 王美云; 聂鑫; 周涛

doi:10.16766/j.cnki.issn.1674-4152.003117

硬膜外间歇脉冲注入技术在肥胖产妇分娩镇痛中对爆发痛的抑制和母婴安全的影响

doi: 10.16766/j.cnki.issn.1674-4152.003117

蒋嫣¹,
柯善高^1, ,,
王芬²,
吴媛¹,
吴焘¹,
周取升¹,
王美云¹,
聂鑫¹,
周涛¹

1.
铜陵市妇幼保健院麻醉科，安徽铜陵 244000
2.
铜陵市妇幼保健院产科

基金项目:

2020年安徽省妇幼健康科研课题 2020FY19

铜陵市卫生健康委医学科研项目卫科研〔2019〕25号

详细信息

通讯作者:
柯善高，E-mail：1271933430@qq.com

中图分类号: R614.42 R714.3
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出版历程
- 收稿日期: 2021-08-16
- 网络出版日期: 2023-09-13

Effect of programmed intermittent epidural bolus technique on burst pain suppression and the safety of maternal and infant labour analgesia in obese parturients

1.
Department of Anesthesiology, Women and Children's Hospital of Tongling, Tongling, Anhui 244000, China

摘要

摘要: 目的通过观察肥胖产妇腰硬联合分娩镇痛中应用硬膜外间歇脉冲注入技术(PIEB)后的分娩疼痛、爆发痛发生率、分娩相关情况，探讨PIEB在肥胖产妇腰硬联合分娩镇痛中的有效性与安全性。方法选择2020年4月—2021年8月铜陵市妇幼保健院临产足月单胎初产妇100例，采用随机数字法分为PIEB组和连续硬膜外输注(CEI)组，每组50例。比较2组分娩镇痛前后不同时间点的VAS评分、爆发痛情况、镇痛药用量、产程和分娩相关情况、不良反应和产妇满意度。结果最终PIEB组44例，CEI组42例纳入研究。VAS评分的组间、各时点间比较、组别与时间的交互作用均有统计学意义(均P < 0.05)。PIEB组爆发痛发生率较CEI组低[27.3%(12/44) vs. 50.0%(21/42)]，首发时间延迟[(281.27±77.88)min vs. (201.20±48.26)min]，患者自控镇痛(PCA)按压次数减少[(1.46±0.65)次vs. (2.29±1.15)次]，PCA>1次占比更低[15.9%(7/44) vs. 38.1%(16/42)]，单位时间麻药用量较少[(8.32±1.60) mg/h vs. (9.12±2.01) mg/h]，侧切发生率更低[13.6%(6/44) vs. 33.3%(14/42)]，但使用缩宫素例数增多[52.3%(23/44) vs. 30.9%(13/42)]，差异均有统计学意义(均P < 0.05)。结论 PIEB用于肥胖产妇腰硬联合分娩镇痛可减少爆发痛，延迟爆发痛出现时间，减少麻药用量，母婴安全性高。
- 硬膜外间歇脉冲注入技术 /
- 腰硬联合 /
- 肥胖产妇 /
- 分娩镇痛 /
- 爆发痛
Abstract: Objective To evaluate the efficacy and safety of programmed intermittent epidural bolus (PIEB) in combined lumbar and epidural labour analgesia in obese parturients, by observing the incidence of labour pain, expulsion pain and related conditions after PIEB was applied in the analgesia of combined lumbar and epidural labour in obese parturients. Methods A total of 100 full-term singleton primigravida in Tongling Maternal and Child Health Hospital from April 2020 to August 2021 were randomly divided into PIEB group and continuous epidural infusion (CEI) group by random number method, with 50 cases in each group. Pain VAS scores at various time points before and after labour analgesia, pain onset, analgesic dosage, labour and delivery related conditions, adverse effects and maternal satisfaction were compared between the two groups. Results Finally, 44 cases in PIEB group and 42 cases in CEI group were included in the study. The comparison of pain VAS scores between groups, comparison between time points and the interaction between group and time were all statistically significant (all P < 0.05). The incidence of pain onset was lower in the PIEB group than in the CEI group [27.3% (12/44) vs. 50.0% (21/42)], the onset time was delayed [(281.27±77.88) min vs. (201.20±48.26) min], the number of PCA compressions was reduced [(1.46±0.65) times vs. (2.29±1.15) times], the proportion of PCA>1 time was lower [15.9% (7/44) vs. 38.1% (16/42)], the amount of anesthetic per unit time was lower [(8.32±1.60) mg/h vs. (9.12±2.01) mg/h], the incidence of lateral incision was lower [13.6% (6/44) vs. 33.3% (14/42)], while the use of oxytocin increased [52.3% (23/44) vs. 30.9% (13/42)], and the differences were statistically significant (all P < 0.05). Conclusion The application of PIEB used in obese parturients for lumbar and hard labour analgesia can reduce the outbreak of pain, delay the onset of pain, reduce the amount of anaesthesia, with high safety for mother and child.
- Programmed intermittent epidural bolus /
- Combined spinal and epidural anaesthesia /
- Obese parturients /
- Labor analgesia /
- Outburst pain

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表 1 2组肥胖产妇一般情况比较

Table 1. Comparison of the general situation of obese parturients in 2 groups

组别	例数	年龄(x±s，岁)	产前BMI(x±s)	孕周(x±s，周)	宫口扩张(x±s，cm)	高血压[例(%)]	糖尿病[例(%)]
PIEB组	44	27.60±3.13	30.82±2.41	39.33±1.14	2.61±0.73	3(6.8)	4(9.1)
CEI组	42	27.96±2.88	30.32±2.26	39.73±0.95	2.62±0.78	4(9.5)	5(11.9)
统计量		0.587^a	0.991^a	1.763^a	0.061^a	0.004^b	0.005^b
P值		0.558	0.324	0.082	0.974	0.949	0.941
注：^a为t值，^b为χ²值。

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表 2 2组肥胖产妇分娩镇痛后各时间点VAS评分比较(x ±s，分)

Table 2. Comparison of VAS scores at different time points after labor analgesia in 2 groups(x ±s, points)

组别	例数	T0	T1	T2	T3	T4	T5	T6	T7	T8	T9
PIEB组	44	8.05±0.76	0.28±0.07^a	0.45±0.11^a	1.22±0.23^a	1.41±0.62^a	1.93±0.39^a	2.00±0.39^a	2.44±0.63^a	2.70±0.71^a	0.71±0.14^a
CEI组	42	8.29±0.94	0.26±0.06^a	0.49±0.16^a	1.51±0.33^a	1.90±0.89^a	2.23±0.62^a	2.44±0.51^a	2.89±0.52^a	2.91±0.61^a	0.74±0.17^a
F值		0.948	1.420	1.356	3.641	2.693	2.250	3.606	5.431	1.468	0.895
P值		0.346	0.159	0.179	0.001	0.009	0.029	0.001	< 0.001	0.146	0.373
注：与同组镇痛前比较，^aP < 0.05。

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表 3 2组肥胖产妇爆发痛发生情况比较

Table 3. Comparison of the occurrence of outburst pain in two groups of obese parturients

组别	例数	爆发痛发生[例(%)]	镇痛开始到发生时间(x±s，min)	发生时VAS评分(x±s，分)	发生时宫口扩张(x±s，cm)	自控镇痛按压次数(x±s，次)	PCA>1次[例(%)]	第二产程停泵[例(%)]
PIEB组	44	12(27.3)	281.27±77.88	4.73±0.60	6.35±1.94	1.46±0.65	7(15.9)	12(27.3)
CEI组	42	21(50.0)	201.20±48.26	4.56±0.56	5.97±1.55	2.29±1.15	16(38.1)	8(19.0)
统计量		4.694^a	5.699^b	1.357^b	1.001^b	3.546^b	5.399^a	0.815^a
P值		0.030	< 0.001	0.179	0.320	0.001	0.020	0.367
注：^a为χ²值，^b为t值。

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表 4 2组肥胖产妇分娩过程中各项指标及新生儿情况比较

Table 4. Comparison of various indicators and newborn during delivery between two groups of obese parturients

项目	PIEB组(n=44)	CEI组(n=42)	统计量	P值
分娩方式[例(%)]
中转剖宫产	3(6.8)	5(11.9)	0.194^a	0.660
产钳	2(4.5)	2(4.8)	0.221^a	0.642
侧切	6(13.6)	14(33.3)	4.671^a	0.031
自然分娩(会阴保护)	33(75.0)	21(50.0)	5.748^a	0.017
产程时间(x±s，min)
第一产程	623.10±137.67	612.16±110.65	0.405^b	0.687
第二产程	72.75±16.95	79.62±19.02	1.770^b	0.080
第三产程	6.37±1.07	6.69±1.20	1.307^b	0.195
镇痛时间(x±s，min)	506.44±118.70	478.62±132.21	1.028^b	0.307
罗哌卡因用量(x±s，mg/h)	8.32±1.60	9.12±2.01	2.047^b	0.044
产后出血量(x±s，mL)	290.68±68.60	266.82±59.88	1.715^b	0.090
新生儿体重(x±s，kg)	3.59±0.47	3.52±0.44	0.712^b	0.478
新生儿Apgar评分(x±s，分)	9.95±0.30	9.93±0.26	0.329^b	0.742
脐血pH值(x±s)	7.22±0.72	7.23±0.56	0.072^b	0.943
使用缩宫素[例(%)]	23(52.3)	13(30.9)	4.013^a	0.045
人工破膜[例(%)]	8(18.2)	12(28.6)	1.300^a	0.254
注：^a为χ²值，^b为t值。

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表 5 2组肥胖产妇不良反应和产后随访情况比较[例(%)]

Table 5. Comparison of adverse reactions and postpartum follow-up of obese parturients in 2 groups[cases(%)]

组别	例数	瘙痒	寒战	恶心呕吐	尿潴留	胎心一过性减慢	运动神经阻滞	穿刺点疼痛	腰痛	下肢感觉异常	满意度评分 < 7分
PIEB组	44	8(18.2)	1(2.3)	4(9.1)	6(13.6)	3(6.8)	0	6(13.6)	3(6.8)	0	0
CEI组	42	6(14.3)	1(2.4)	5(11.9)	7(16.7)	4(9.5)	2(4.8)	7(16.7)	3(7.1)	2(4.8)	3(7.1)
χ²值		0.239	< 0.001	0.005	0.154	0.004	0.561	0.154	0.131	0.561	1.480
P值		0.999	1.000	0.941	0.695	0.949	0.454	0.695	0.716	0.454	0.224

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