摘要
目的:对比硬脊膜穿破硬膜外(DPE)、蛛网膜下腔-硬膜外联合(CSE)、硬膜外(EP)阻滞用于分娩镇痛效果。方法:选取2020年5月-2020年12月本院行阴道分娩并要求分娩镇痛的产妇186例,随机数字表法分3组,分别行DPE阻滞、CSE阻滞与EP阻滞,对比3组镇痛效果、产程时间、新生儿Apgar评分、分娩方式及不良反应。结果:DPE组肛门坠落感(1.6%)、不对称阻滞(1.6%)发生比例低于EP组,双侧感觉阻滞平面至S2占比(98.4%)高于EP组,VAS<2分用时(9.6±2.2min)短于EP组,Bromage分级低于CSE组,DPE组、CSE组舒芬太尼、罗哌卡因用量均少于EP组(均P<0.05);3组产程时间、中转剖宫产率、器械助产率,以及新生儿Apgar评分均无差异(均P>0.05);DPE组瘙痒(1.6%)、低血压(3.2%)发生率低于CSE组(P<0.05),而DPE组与EP组无差异(P>0.05)。结论:DPE阻滞用于分娩镇痛可获得更完善的神经阻滞效果,麻醉药用量少且起效快,不良反应少,有一定临床应用价值。
Objective: To compare the effects of dural puncture epidural(DPE), combined spinal and epidural(CSE), and epidural(EP) block in labor analgesia. Methods: 186 pregnant women who underwent vaginal delivery and required labor analgesia were selected and were divided into group A, group B, and group C according to the random number table from February 2019 to May 2020. The women in group A underwent DPE block, the women in group B underwent CSE block, and the women in group C underwent EP block. The analgesic effect, duration of labor, mode of delivery, and adverse reactions rate of the women, and neonatal Apgar score were compared among the three groups. Results: The proportion of the anal falling sensation(1.6%) and the asymmetric block(1.6%) of the women in group A were significant lower than those of the women in group C, the proportion of bilateral sensory block plane to S2(98.4%) of the women in group A was significant higher than that of the women in group C, the time of VAS <2 minutes(9.6±2.2 min) of the women in group A was significant shorter than that of the women in group C. The Bromage grade of the women in group A was significant lower than that of the women in group B. The dosages of sufentanil and ropivacaine used of the women in group A and group B were significant lower than those of the women in group C(all P<0.05). There were no significant differences in the duration of labor, the rate of transfer to cesarean section, and the rate of instrumental midwifery of the women, and the Apgar score of neonates among the three groups(all P>0.05). The incidences of pruritus(1.6%) and hypotension(3.2%) of the women in group A were significant lower than those of the women in group B(P<0.05), but which had no significant differences between group A and group C(P>0.05). Conclusion: DPE block used in labor analgesia can achieve perfect nerve block effect with less dosage of anesthetics, onset of anesthetics quicker, and few adverse reactions, so it has certain clinical application value.
作者
雷云龙
刘馨
张望
梁吉文
LEI Yunlong;LIU Xin;ZHANG Wang;LIANG Jiwen(The Second People's Hospital of Lanzhou,Gansu Province,730046;The First Hospital of Lanzhou University)
出处
《中国计划生育学杂志》
2021年第6期1172-1175,共4页
Chinese Journal of Family Planning
基金
2019年兰州大学第一医院院内(ldyyn2019-59)。
