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分娩镇痛硬膜外间隙镇痛药液用量对中转剖宫产时硬膜外麻醉效果的影响:前瞻性队列研究

赵娜 李晓光 汪愫洁 徐涛 白云波 徐铭军

赵娜, 李晓光, 汪愫洁, 徐涛, 白云波, 徐铭军. 分娩镇痛硬膜外间隙镇痛药液用量对中转剖宫产时硬膜外麻醉效果的影响:前瞻性队列研究[J]. 协和医学杂志, 2021, 12(3): 339-345. doi: 10.12290/xhyxzz.2020-0076
引用本文: 赵娜, 李晓光, 汪愫洁, 徐涛, 白云波, 徐铭军. 分娩镇痛硬膜外间隙镇痛药液用量对中转剖宫产时硬膜外麻醉效果的影响:前瞻性队列研究[J]. 协和医学杂志, 2021, 12(3): 339-345. doi: 10.12290/xhyxzz.2020-0076
ZHAO Na, LI Xiaoguang, WANG Sujie, XU Tao, BAI Yunbo, XU Mingjun. The Influence of Epidural Local Anesthetics Consumption Volume during Labor Analgesia on the Effect of Epidural Anesthesia When Undergoing Intrapartum Cesarean Delivery[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(3): 339-345. doi: 10.12290/xhyxzz.2020-0076
Citation: ZHAO Na, LI Xiaoguang, WANG Sujie, XU Tao, BAI Yunbo, XU Mingjun. The Influence of Epidural Local Anesthetics Consumption Volume during Labor Analgesia on the Effect of Epidural Anesthesia When Undergoing Intrapartum Cesarean Delivery[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(3): 339-345. doi: 10.12290/xhyxzz.2020-0076

分娩镇痛硬膜外间隙镇痛药液用量对中转剖宫产时硬膜外麻醉效果的影响:前瞻性队列研究

doi: 10.12290/xhyxzz.2020-0076
基金项目: 

首都医科大学附属北京妇产医院青年基金专项课题资助项目 FCYYQN-201909

详细信息
    通讯作者:

    徐铭军 电话:010-52273799,E-mail: xumingjun1339@ccmu.edu.cn

  • 中图分类号: R614.3;R714.7

The Influence of Epidural Local Anesthetics Consumption Volume during Labor Analgesia on the Effect of Epidural Anesthesia When Undergoing Intrapartum Cesarean Delivery

Funds: 

Beijing Obstetrics and Gynecology Hospital, Capital Medical University FCYYQN-201909

More Information
  • 摘要:   目的  探讨椎管内阻滞分娩镇痛硬膜外间隙镇痛药液用量对中转剖宫产时硬膜外麻醉效果的影响。  方法  前瞻性收集并分析2019年5月至2020年2月在首都医科大学附属北京妇产医院接受椎管内阻滞分娩镇痛且中转剖宫产产妇的临床资料。以纳入本研究的所有产妇分娩镇痛期间硬膜外间隙镇痛药液用量的算术均值(60 mL)为分界值,将其分为高容量组(硬膜外间隙镇痛药液用量≥60 mL)和低容量组(硬膜外间隙镇痛药液用量<60 mL)。中转剖宫产时,通过原分娩镇痛置入的硬膜外导管给予试验剂量的1.5%利多卡因3 mL及1%利多卡因+0.5%罗哌卡因混合液10~20 mL进行硬膜外麻醉,比较两组产妇硬膜外麻醉失败率及麻醉效果。  结果  共36例符合纳入和排除标准的产妇入选本研究。其中高容量组17例、低容量组19例。高容量组硬膜外麻醉失败率明显高于低容量组(23.5% 比0, P=0.040)。两组产妇剖宫产术中局部麻醉药用量(P=0.057)、给予首次麻醉诱导剂量至切皮时间(P=0.290)、给予首次麻醉诱导剂量至术毕时间(P=0.748)均无显著性差异。36例产妇均顺利完成剖宫产术(4例硬膜外麻醉失败者改行腰硬联合麻醉),均无产妇和新生儿不良事件发生。Pearson相关法分析显示,给予首次麻醉诱导剂量后10 min体表感觉阻滞平面与硬膜外间隙镇痛药液用量明显相关(r=0.509, P=0.003),与单位时间镇痛药液用量无线性相关(r=0.272, P=0.125)。高容量组给予首次麻醉诱导剂量后10 min右侧体表感觉阻滞平面[T9(T6, T9)比T6(T4, T7), P=0.048]及术毕右侧运动阻滞分级[1(0, 1)比2(1, 3), P=0.034]均低于低容量组。高容量组在切皮后分离肌肉时主诉不适(23.1%比0, P=0.058)和回纳子宫并腹腔探查时主诉不适(30.8%比15.8%, P=0.401)的产妇比率与低容量组均无显著性差异。  结论  接受椎管内阻滞分娩镇痛且中转剖宫产的产妇,若硬膜外间隙镇痛药液用量增多,不仅增加后续硬膜外麻醉失败风险,且影响硬膜外麻醉效果。
    作者贡献: 赵娜负责研究设计、病例招募、数据采集整理、论文撰写;李晓光、徐铭军参与研究设计、论文撰写;汪愫洁、白云波负责病例招募、数据采集整理;徐涛负责数据整理、统计分析。
    利益冲突: 无
  • 表  1  两组产妇术前资料比较

    指标 高容量组(n=17) 低容量组(n=19) P
    年龄(x±s, 岁) 31.59±3.16 31.26±3.48 0.772
    身高(x±s, cm) 162.47±4.96 160.47±5.53 0.265
    体质量(x±s, kg) 72.35±6.72 69.74±10.05 0.371
    体质量指数(x±s, kg/m2) 27.43±2.49 27.04±3.40 0.695
    孕周(x±s, 周) 39.24±0.90 39.74±0.93 0.112
    术前宫口开指程度[M(P25, P75), cm] 3(2, 5.5) 2(2, 3) 0.327
    镇痛时间(x±s, h) 11.44±3.19 6.32±2.74 0.000
    镇痛药液用量(x±s, mL) 88.47±23.75 36.11±14.64 0.000
    单位时间镇痛药液用量(x±s, mL/h) 8.02±2.25 5.89±1.57 0.002
    镇痛初始启动方式[n(%)] 1.000
      硬膜外镇痛 12(70.6) 14 (73.7)
      腰硬联合镇痛 5(29.4) 5(26.3)
    中转剖宫产指征[n(%)] 0.001
      相对头盆不称 15(88.2) 6(31.6)
      胎儿窘迫 0(0) 7(36.8)
      宫内感染 1(5.9) 4(21.1)
      其他 1(5.9) 2(10.5)
    下载: 导出CSV

    表  2  两组产妇术中资料比较(x±s)

    指标 高容量组(n=13) 低容量组(n=19) P
    术中局麻药用量(mL) 15.03±1.19 14.18±1.37 0.057
    给予首次麻醉诱导剂量至切皮时间(min) 22.00±4.56 20.53±3.19 0.290
    给予首次麻醉诱导剂量至术毕时间(min) 67.31±19.77 65.47±12.26 0.748
    输液总量(mL) 823.08±101.27 878.95±154.84 0.350
    出血量(mL) 503.85±172.56 466.32±100.29 0.677
    下载: 导出CSV

    表  3  两组产妇硬膜外麻醉效果比较

    指标 高容量组(n=13) 低容量组(n=19) P
    给予首次麻醉诱导剂量后10 min[M(P25, P75)]
      左侧体表感觉阻滞平面 T9(T4, T10) T6(T4, T7) 0.175
      右侧体表感觉阻滞平面 T9(T6, T9) T6(T4, T7) 0.048
      左侧运动阻滞分级 0(0, 0) 0(0, 1) 0.233
      右侧运动阻滞分级 0(0, 1) 0(0, 1) 0.672
    术毕[M(P25, P75)]
      左侧体表感觉阻滞平面 T4(T3, T4) T4(T2, T4) 0.361
      右侧体表感觉阻滞平面 T4(T3, T4) T4(T2, T4) 0.467
      左侧运动阻滞分级 1(0, 1) 2(1, 3) 0.095
      右侧运动阻滞分级 1(0, 1) 2(1, 3) 0.034
    切皮后分离肌肉主诉不适[n(%)] 0.058
      有 3(23.1) 0(0)
      无 10(76.9) 19(100)
    回纳子宫并腹腔探查时主诉不适[n(%)] 0.401
      有 4(30.8) 3(15.8)
      无 9(69.2) 16(84.2)
    下载: 导出CSV
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出版历程
  • 收稿日期:  2020-12-22
  • 录用日期:  2021-01-25
  • 刊出日期:  2021-05-30

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