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*基金项目：江西省卫生健康委科技计划项目（202130791）

【摘要】 目的：评价硬脊膜穿破硬膜外（DPE）阻滞联合程控硬膜外间隙脉冲给药（PIEB）模式在经产妇分娩镇痛中的应用效果及对新生儿的影响。方法：选择2023年3—4月江西省妇幼保健院自然分娩行椎管内分娩镇痛的孕37～42周、单胎头位、美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级的经产妇180例。采用在线随机数生成器将产妇分为三组：DPE阻滞联合PIEB模式组（DPE+PIEB组，60例）、DPE阻滞联合连续硬膜外输注（CEI）模式组（DPE+CEI组，60例）和单纯硬膜外（EP）阻滞联合CEI模式组（EP+CEI组，60例）。比较三组产妇在30 min内达“满意镇痛”的时长、30 min后无满意镇痛手动推药发生率、镇痛效果和阻滞情况、不良反应和胎儿娩出情况。结果：DPE+PIEB组和DPE+CEI组产妇达满意镇痛时长快于EP+CEI组（P<0.05）。三组产妇罗哌卡因总消耗量为：DPE+PIEB组0.05），新生儿出生后1 min和5 min时Apgar评分≤7分的发生率均为0。结论：DPE阻滞联合PIEB模式用于经产妇的分娩镇痛可明显缩短药物起效时间，增强镇痛效果，减少罗哌卡因用量，不影响产程进展，且对新生儿无不良影响。

【关键词】 硬脊膜穿破硬膜外阻滞 程控硬膜外间隙脉冲给药模式 分娩镇痛 经产妇

The Application Effect of Dural Puncture Epidural Block Combined with Programmed Intermittent Epidural Bolus Mode in Pain Alleviation during Multipara Delivery/HUA Jing， NIU Jiangfeng， DENG Qun， ZHOU Qun. //Medical Innovation of China， 2024， 21（13）： 00-010

[Abstract] Objective： To evaluate the effect of dural puncture epidural （DPE） block combined with programmed intermittent epidural bolus （PIEB） mode in multipara labor analgesia and its effect on neonates. Method： A total of 180 multipara aged 37-42 weeks， single fetal head position， and classified as class Ⅰ or Ⅱ by the American society of anesthesiologists （ASA） from March to April 2023 at Jiangxi Maternal and Child Health Hospital were selected to undergo intraspinal delivery analgesia. Using an online random number generator， postpartum women were divided into three groups： the DPE block combined with PIEB mode group （DPE+PIEB group， 60 cases）， the DPE block combined with continuous epidural infusion （CEI） mode group （DPE+CEI group， 60 cases）， and the simple epidural （EP） block combined with CEI mode group （EP+CEI group， 60 cases）. The duration of achieving "satisfactory analgesia" within 30 minutes， the incidence of manual medication administration without satisfactory analgesia after 30 minutes， the analgesic effect and blocking situation， adverse reactions， and fetal delivery among three groups of postpartum women were compared. Result： Satisfactory anesthesia was achieved faster in the DPE+CEI group and DPE+PIEB group than that in the EP+CEI group （P<0.05）. The total consumption of Ropivacaine in the three groups was： DPE+PIEB group 0.05）. The incidence of Apgar score ≤7 scores at 1 min and

5 min after birth in all three maternal newborn groups was 0. Conclusion： DPE block combined with PIEB mode for multipara labor analgesia can significantly shorten the onset time of medication， enhance the analgesic effect， reduce the amount of Ropivacaine， does not affect the progress of labor and has no adverse effects on newborns.

[Key words] Dural puncture epidural block Programmed intermittent epidural bolus mode Labor analgesia Multipara

First-author's address： Department of Anesthesiology， Jiangxi Maternal and Child Health Hospital， Nanchang 330006， China

doi：10.3969/j.issn.1674-4985.2024.13.002

近年来，随着我国二孩、三孩政策的实施，我国产妇组成结构发生了巨大变化，经产妇比例升高[1]，回顾以往研究发现，经产妇在分娩过程中往往比初产妇需忍受更大的疼痛，这一表现在第二产程尤为明显[2]。椎管内麻醉作为分娩镇痛的常用技术，可以有效缓解分娩过程中的疼痛，减少产妇应激反应及产后抑郁的发生[3-4]。目前分娩镇痛常用的两种镇痛方式为连续硬膜外阻滞（epidural，EP）和蛛网膜下腔-硬膜外联合阻滞（combined spinal epidural，CSE）。……