硬脊膜穿破硬膜外阻滞技术用于分娩镇痛的临床研究
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梁太汉,男,副主任医师,主要从事妇产科、儿科麻醉工作。

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R 614

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阳江市医疗卫生类科技计划项目资助课题(SF2020091)


Clinical Study of Dural Puncture and Epidural Black Technology for Labor Analgesia
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    摘要:

    摘 要目的:探讨硬脊膜穿破硬膜外阻滞技术用于分娩镇痛的作用。 方法:选择阳江市妇幼保健院 2019 年 1 月至 2020 年 12 月期间收治的 350 例无痛分娩产妇为研究对象,利用随机数表法将其分成硬膜外阻滞(EP)组 50 例和硬脊膜穿 破硬膜外阻滞(DPE)组 300 例,DPE 组 300 例孕妇再随机分成两大组:A 组 150 例(针对给药浓度)、B 组 150 例(针 对硬膜外导管留置长度)。A 组 150 例孕妇随机分组为 3 个小组:A1 组 50 例(0.065 % 罗哌卡因)、A2 组 50 例(0.08 % 罗哌卡因)、A3 组 50 例(0.1 % 罗哌卡因)。B 组 150 例孕妇随机分为 3 个小组:B1 组 50 例(留置长度 3 cm)、B2 组 50 例(留置长度 4 cm)、B3 组 50 例(留置长度 5 cm),比较不同产妇的产程时间、分娩结局和新生儿 Apgar 评分。 结果:DPE 组全部产妇的自然分娩率均高于 EP 组,差异具有统计学意义(P < 0.05)。DPE 组 A1、A2、A3、B1、B2、B3 等观 察对象的分娩方式比较,差异无统计学意义(P > 0.05);DPE 组全部产妇的第一产程和第二产程时间均明显短于 EP 组, 其新生儿 1 min Apgar 评分明显低于 EP,差异具有统计学意义(P < 0.05)。新生儿 5 min Apgar 评分结果与 EP 组比较, 差异无统计学意义(P > 0.05)。A1、A2、A3、B1、B2、B3 等观察对象的第一产程时间、第二产程时间、新生儿 1 min Apgar 评分、新生儿 5 min Apgar 评分比较,差异无统计学意义(P > 0.05)。 结论:DPE 是一种安全性更高的无痛分娩技术, 对于骶神经的阻滞效果更好,起效速度更快,能够保证产妇的安全性,且不同麻醉药物应用方式对于患者的分娩安全性不 会产生直接的影响。

    Abstract:

    AbstractObjective To explore the role of spinal puncture and epidural block technology in labor analgesia. Methods 350 cases of painless laber admitted to Yangjiang Maternity and Child Health Hospital from January 2019 to December 2020 were selected as the study subjects, and were randomly divided into epidural anesthesia (EP) group of 50 cases and dural puncture epidural 300 cases in the block (DPE) group and 300 pregnant women in the DPE group were randomly divided into two groups: 150 cases in group A (for administration concentration) and 150 cases in group B (for indwelling epidural catheter length). 150 pregnant women in group A were randomly divided into three groups: 150 cases in group A1 (0.065% ropivacaine), 50 cases in group A2 (0.08% ropivacaine), and 50 cases in group A3 (0.1% ropivacaine). 150 pregnant women in group B were randomly divided into three groups: 50 cases in group B1 (indwelling length of 3 cm), 50 cases in group B2 (indwelling length of 4 cm), and 50 cases in group B3 (indwelling length of 5 cm). Compare the labor process of different mothers time, delivery outcome and Apgar score of newborns. Results The natural delivery rate of all women in the DPE group was higher than that in the EP group (P < 0.05). There was no statistically significant difference in the way of delivery of observation objects such as A1, A2, A3, B1, B2, B3 in the DPE group (P > 0.05); the time of the first stage of labor and the second stage of labor of all women in the DPE group was significantly shorter than that of EP in the group, the 1-min Apgar score of newborns was significantly lower than EP (P < 0.05). There was no significant difference of the 5 min Apgar score of newborns between the DPE group and EP group (P > 0.05). Comparison of the first stage of labor time, the second stage of labor time, newborn 1min Apgar score, newborn 5min Apgar score in groups A1, A2, A3, B1, B2, B3, and other observation subjects, showed no significantly significant difference (P > 0.05). Conclusion DPE is a more safe and painless delivery technique. It has a better blocking effect on the sacral nerve and a faster onset of action. It can ensure the safety of the parturient, different anesthesia application methods will not have a direct impact on the delivery safety of patients.

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  • 收稿日期:2021-08-20
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  • 在线发布日期: 2023-06-29
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