程控硬膜外间歇脉冲注入模式在分娩镇痛中的应用及其对脐血流及脐动脉血气的影响

doi:10.13481/j.1671-587X.20210525

Abstract

Abstract: Objective

To explore the effect of programmed intermittent epidural bolus（PIEB） mode for labor analgesia and its influence in the umbilical blood flow and umbilical artery blood gas， and to provide the basis for finding a more ideal mode of epidural labor analgesia.

Methods

Ninety cases of full-term singleton neonates who required labor analgesia were randomly divided into PIEB group and continuous epidural infusion （CEI） group by random number table method，with 45 cases in each group.The maternity patients in two groups were given the first dose （0.08 g·L^－1 ropivacaine+0.4 mg·L^－1 dexmedetomidine） 10 mL.The maternity patients in PIEB group were connected to the PIEB analgesia pump 1 h after the injection of the first dose， with the pulse dose of 8 mL·h^－1 and the speed of 7 mL·min^－1；the patients in CEI group were connected to the CEI analgesia pump immediately after the first dose injection， and the continuous background dose was 8 mL·h^－1.The VAS pain scores of the maternity patients in two groups before analgesia （T0）， 30 min after analgesia （T1），1 h after analgesia （T2）， 2 h after analgesia （T3） and full-time uterine opening （T4） were compared. The umbilical artery pulsatitly index （PI）， umbilical artery resistance index （RI） and the ratios of systolic peak to diastolic peak （S/D） of fetal umbilical artery blood flow velocity of the patients at T0－T3 were compared. The umbilical artery blood gas pH values， residual alkali （BE） values and the newborn Apgar scores immediately after delivery of the maternity patients in two group were compared.The first stage of labor， the second stage of labor， satisfaction and adverse reactions were compared between two groups.

Results

There were no differences in the VAS scores of the patients at T0， T1， T2 and T3 between two groups （P>0.05）.The VAS score of the maternity patients in PIEB group at the T4 time point was lower than that in CEI group （P<0.05）. There were no differences in the fetal PI， RI， and S/D ratios of the maternity patients at different time points between two groups （P>0.05）.There were no statistically significant differences in the umbilical artery blood gas pH values and BE values of the maternity patients between two groups（P>0.05）， and there was no significant difference in the Apgar score between two groups （P>0.05）. There were no significant differences in the first stage of labor， the second stage of labor and the adverse reactions between two groups（P>0.05）. The score of satisfaction with analgesia of the maternity patients in PIEB group was significantly higher than that in CEI group（P<0.05）.

Conclusion

PIEB mode for labor analgesia has no significant effect on the umbilical blood flow and umbilical artery blood gas， and has better safety.

Key words: programmed intermittent epidural bolus, continuous epidural infusion, labor analgesia, umbilical artery flow, umbilical artery blood gas analysis

CLC Number:

R614.4

Figures/Tables 5

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References 20

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Group	Age（year）	BMI（kg·m^－2）	Gestation（week）	Cervix dilatation （l/cm）	ASA classification [n（%）]
Group	Age（year）	BMI（kg·m^－2）	Gestation（week）	Cervix dilatation （l/cm）	ClassⅠ	ClassⅡ
PIEB	28.47±5.94	27.68±2.14	40.05±2.07	2.31±0.61	18（40.00）	27（60.00）
CEI	27.13±7.98	27.71±2.37	39.98±2.12	2.27±0.68	20（44.44）	25（56.56）
t/χ²	0.904	－0.063	0.158	0.294	0.122
P	0.369	0.950	0.874	0.770	0.727

Group	VAS score
Group	T0	T1	T2	T3	T4
PIEB	8.00（7.00，8.00）	0.00（0.00，1.00）	0.00（0.00，0.00）	0.00（0.00，0.00）	0.00（0.00，2.00）
CEI	8.00（8.00，8.00）	0.00（0.00，1.00）	0.00（0.00，0.00）	0.00（0.00，0.00）	2.00（0.00，2.50）
Z	0.122	0.182	1.652	1.031	3.128
P	0.903	0.856	0.099	0.303	0.002

Group	PI
Group	T0	T1	T2	T3
PIEB	0.74±0.10	0.71±0.09	0.69±0.10	0.67±0.11
CEI	0.76±0.12	0.70±0.10	0.69±0.11	0.68±0.11
Group	RI
Group	T0	T1	T2	T3
PIEB	0.51±0.05	0.50±0.07	0.49±0.06	0.49±0.06
CEI	0.53±0.06	0.51±0.07	0.51±0.10	0.49±0.06
Group	S/D
Group	T0	T1	T2	T3
PIEB	2.07±0.17	2.00±1.13	1.97±0.19	1.95±0.17
CEI	2.11±0.35	1.98±0.32	1.95±0.32	1.92±0.34

Group	pH value	BE value	Apgar score (point)
Group	pH value	BE value	1 min	5 min	10 min
PIEB	7.17±0.89	－3.38±3.06	8.98±0.26	10.00±0.00	10.00±0.00
CEI	7.31±0.32	－4.24±2.72	9.00±0.21	10.00±0.00	10.00±0.00
t	1.523	1.407	1.263	0.000	0.000
P	0.128	0.163	0.281	1.000	1.000

Group	First stage of labor （t/min）	Second stage of labor （t/min）	Satisfaction score	Adverse reaction[n(η/%)]
Group	First stage of labor （t/min）	Second stage of labor （t/min）	Satisfaction score	Shiver	Urinary retention	Nausea and vomiting
PIEB	562.91±192.13	71.44±32.04	8.67±0.83	3（6.67）	9（20.00）	2（4.44）
CEI	545.89±204.77	80.09±40.22	7.72±0.72	4（8.89）	7（15.56）	2（4.44）
t/χ²	0.407	1.128	5.800	0.179^*	0.304	0.262^*
P	0.685	0.263	<0.01	0.673	0.581	0.609

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