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间断硬膜外注射与持续硬膜外输注在自控硬膜外分娩镇痛中的比较研究
A randomized comparison of intermittent bolus with continuous infusion in combination with patient-controlled epidural analgesia in labor
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DOI:
作者:
吉杰,徐振东,金春红,刘志强
Ji Jie, Xu Zhendong,Jin Chunhong, Liu Zhiqiang
作者单位:
上海市第一妇婴保健院麻醉科
Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Shanghai
关键词:
镇痛,产科;分娩;注射,硬膜外;规律间断
Analgesia, obstetrical;Labor;Injection,epidural;Regular intermittent
摘要:
目的 比较间断硬膜外注射(intermittent epidural bolus,IEB)与持续硬膜外输注(continuous epidural infusion,CEI)分别复合自控硬膜外镇痛(patient-controlled epidural analgesia, PCEA)在分娩镇痛中的效果。 方法 硬膜外镇痛下行分娩镇痛的单胎足孕初产妇50例,20-40岁,ASA分级I-II级,随机分为两组(n=25):IEB+PCEA(A组)、CEI+PCEA(B组),镇痛药物配方均为0.075%罗哌卡因复合0.3ug/ml舒芬太尼。A组每小时硬膜外单次注射8ml,B组为持续输注8ml/h。两组产妇PCEA剂量均为5ml,锁定时间20min,每小时最大剂量25ml。记录镇痛前、镇痛后5、10、30、60min及宫口开全时的视觉模拟(VAS)评分,爆发痛的发生情况,PCEA的使用率和局麻药用量;记录产程,出血量,母胎分娩结局及药物不良反应。结果 A组产妇每小时镇痛药物消耗量及爆发痛发生率显著低于B组(p<0.05),首次爆发痛时宫口大小及时间显著大于B组(p<0.05),产妇满意度A组显著高于B组(p<0.05) 结论 IEB+PCEA较CEI+PCEA在预防和推迟爆发痛发生上更有效,同时每小时镇痛药物消耗量更少,产妇满意度更高。
Objective To compare the effect of intermittent epidural bolus(IEB) with continuous epidural infusion(CEI) in combination with patient-controlled epidural analgesia for labor . Methods Fifty healthy ASA I-II nulliparous parturients, aged 20-40 years old, were equally randomized into group A(IEB+PCEA) and group B(CEI+PCEA). Group A received IEB with 8ml of 0.075% ropivacaine and 0.3ug/ml sufentanil hourly. Group B received the same dose of solution via CEI.All parturients had a PCEA bolus volume 5ml, lockout time of 20 mins and maximum hourly dose 25ml.The VAS scores were recorded before and at 5,10,30,60 mins after analgesia. Incidence of breakthrough pain, use of PCEA, consumption of ropivacaine, obstetric outcomes, adverse effects, Apgar scores and overall maternal satisfaction with analgesia were recorded. Results The hourly consumption of ropivacaine and incidence of breakthrough pain were significantly lower in group A than in group B(both p<0.05).The mean time to first breakthrough pain and degree of cervical dilation at that time were significantly longer in group A(both p<0.05).Adverse effects, mode of delivery and neonatal outcome were comparable in both groups.. Conclusion Maintenance of epidural analgesia with IEB compared with CEI resulted in lower incidence of breakthrough pain and a longer duration of effective analgesia with greater patient satisfaction besides less analgesic consumption.
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