个体化镇痛时机对硬膜外分娩镇痛效果的影响

摘要

Objective To investigate whether preset epidural catheter and individualized onset time could improve the effect of epidural labor analgesia.Methods This was an open-label,random-ized,controlled trial.The nulliparae aged from 18 to 35 years,with single cephalic term pregnancy, were randomized into two groups.In the individualized group,epidural catheterization was performed at the beginning of labor (emergence of regular contractions and nearly disappearance of cervix),and epidural analgesia was initiated when asked by parturients and the numeric rating scale (NRS,a verbal rating score from 0 to 10 for pain,in which 0 represented no pain and 10 the worst pain imagi-nable)pain score ≥ 5 .In the control group,epidural analgesia was initiated at cervical dilation of≥ 1 cm.The primary outcome measures were the most severe NRS pain score during labor and the pro-portion of the most severe NRS pain score ≥ 7 evaluated at 24 hours after delivery.Results A total of 194 parturients completed the study,among whom 97 were in the individualized group and 97 in the control group.The most severe labor pain score during labor [median 9 (IQR 8-10)in the individ-ualized group vs 9 (8-10)in the control group,P=0.201]and the proportion having the most severe pain score ≥ 7 [94 cases (96.9%)in the individualized group vs 89 cases (91.8%)in the control group,P=0.1 2 1 ]did not differ significantly between the two groups.There were no significant differences of adverse events between the two groups.Conclusion For the nulliparae with single ce-phalic term pregnancy suitable for vaginal delivery, the effects of individualized epidural labor analgesia are comparable to that of traditional analgesia (beginning at cervical dilation of ≥ 1 cm). The individualized analgesia is safe.%目的 观察提前预置硬膜外导管,根据产妇需要开始镇痛的个体化镇痛模式对分娩镇痛效果的影响.方法 这是一项标签开放的随机对照研究.选择单胎、足月、头位妊娠初产妇,年龄18~35 岁,随机分为两组.个体化组产妇在产程开始(出现规律宫缩、宫颈接近消失)行硬膜外穿刺置管,当产妇有镇痛需求且 NRS评分≥5 分时给予硬膜外镇痛;对照组在宫口开大 1 cm时行硬膜外镇痛.主要研究终点是分娩过程最严重疼痛 NRS 评分及分娩时 NRS 评分≥7 分产妇比例.结果 194例产妇完成研究,分娩过程中两组最严重疼痛程度 NRS评分[个体化组 9(8~10)分 vs 对照组 9(8~10)分,P=0.201]及分娩时 NRS评分≥7 分产妇比例[个体化组 94 例(96.9%)vs 对照组89 例(91.8%),P=0.121]差异均无统计学意义.两组不良事件发生率差异无统计学意义.结论 对于单胎、足月、头位且产科评估可试行阴道分娩的产妇,根据产妇需求实施硬膜外分娩镇痛的效果与传统的镇痛时机(宫口开放 1 cm)相当.