硬脊膜穿刺硬膜外阻滞联合程序性硬膜外间歇脉冲注射用于分娩镇痛时的最佳时间间隔

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硬脊膜穿刺硬膜外阻滞联合程序性硬膜外间歇脉冲注射用于分娩镇痛时的最佳时间间隔

贵州医科大学    麻醉与心脏电生理课题组

翻译：柏雪  编辑：张中伟  审校：曹莹

背景：硬脊膜穿刺硬膜外阻滞技术(DPE)（即完成硬膜外穿刺后，暂不置管，先用腰麻针刺破硬脊膜，但并不直接在蛛网膜下腔注射药物，而是直接留置硬膜外导管 ） 和程序性硬膜外间歇脉冲注射(PIEB) 技术是椎管内分娩镇痛的最新进展。以前的研究已经调查了使用标准硬膜外技术启动分娩镇痛时有效镇痛的PIEB最佳时间间隔。然而，尚不清楚这些发现在使用DPE时是否适用。

研究方法：患者被随机分配到5个不同的PIEB间隔中的1个:35分钟(35组)、40分钟(40组)、45分钟(45组)、50分钟(50组)和55分钟(55组)。在用25号 Whitacre 针穿刺硬脊膜后，通过硬膜外注射 15 mL 0.1% 罗哌卡因和 0.5 μg/mL 舒芬太尼，根据要求使用DPE技术开始分娩镇痛。有效镇痛指在分娩的第一阶段不需要患者额外的自控推注。使用概率回归估计对50% 的患者 (EI50) 和90% 的患者 (EI90) 有效的PIEB间隔。

主要结果：100 名分娩产妇接受了 DPE 技术，其中 93 名继续使用PIEB维持镇痛，使用固定体积的10 mL 0.1% 罗哌卡因和0.5 μg/mL 舒芬太尼。35分钟、40分钟、45分钟、50分钟、55分钟组患者PIEB有效镇痛的比例分别为89.5%(17/19)、84.2%(16/19)、82.4%(14/17)、52.6%(11/19)、36.8%(7/19)。EI50和EI90的估计值分别为52.5分钟(95% CI, 48.4-62.6)和37.0分钟(95% CI, 28.4-40.9)。

结论：使用DPE技术后PIEB有效镇痛的最佳时间间隔估计值与以往研究报道的使用常规硬膜外技术开始镇痛时相当。

原始文献来源：Han-Qing Yao, MD，Jia-Yue Huang, MDJia-Li Deng, MD，et, al. Randomized Assessment of the Optimal Time Interval Between Programmed Intermittent Epidural Boluses When Combined With the Dural Puncture Epidural Technique for Labor Analgesia. Regional Anesthesia, accepted for publication June 20, 2022.

英文原文       

Randomized Assessment of the Optimal Time Interval Between Programmed Intermittent Epidural Boluses When Combined With the Dural Puncture Epidural Technique for Labor Analgesia.

BACKGROUND: The dural puncture epidural (DPE) and programmed intermittent epidural bolus (PIEB) techniques are recent advances in neuraxial labor analgesia. Previous studies have investigated the PIEB optimal interval for effective analgesia when a standard epidural technique is used to initiate labor analgesia. However, it is unknown whether these findings are applicable when DPE is used.

METHODS: Patients were randomized into 1 of 5 groups with PIEB intervals of 35, 40, 45, 50, or 55 minutes. Labor analgesia was initiated on request with a DPE technique by epidural injection over 2 minutes of 15 mL of ropivacaine 0.1% with sufentanil 0.5 μg/mL after a dural puncture with a 25-gauge Whitacre needle. Effective analgesia was defined as no additional requirement for a patient-controlled bolus during the first stage of labor. The PIEB interval that was effective in 50% of patients (EI50) and 90% of patients (EI90) was estimated using probit regression.

RESULTS: One hundred laboring parturients received the DPE technique of whom 93 proceeded to have analgesia maintained with PIEB using 10 mL boluses of ropivacaine 0.1% and sufentanil 0.5 μg/mL. Totals of 89.5% (17/19), 84.2% (16/19), 82.4% (14/17), 52.6% (11/19), and 36.8% (7/19) of patients in groups 35, 40, 45, 50, and 55, respectively, received effective PIEB analgesia. The estimated values for EI50 and EI90 were 52.5 (95% CI, 48.4–62.6) minutes and 37.0 (95% CI, 28.4–40.9) minutes, respectively.

CONCLUSION: The estimate of the PIEB optimal interval for effective analgesia after the DPE technique was comparable to that reported in previous studies when analgesia was initiated using a conventional epidural technique.

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