硬膜外穿刺与腰硬联合麻醉在分娩镇痛后胎儿延长减速发生率的比较：一项初步研究。

Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study.

机构信息

Department of Anesthesiology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Clinical Research Support Center, Juntendo University, 2-1-1 Hongo Bunkyo-ku Tokyo, 113-8421, Tokyo, Japan.

出版信息

BMC Pregnancy Childbirth. 2023 Mar 16;23(1):182. doi: 10.1186/s12884-023-05473-0.

DOI:10.1186/s12884-023-05473-0

PMID:36927405

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10018578/

Abstract

BACKGROUND

Abnormal cardiotocogram (CTG) tracing may appear after induction of neuraxial labor analgesia. Non-reassuring fetal status (NRFS) indicated by severely abnormal tracings, such as prolonged deceleration (PD) or bradycardia, can necessitate immediate operative delivery. Combined spinal epidural analgesia (CSEA) is known to result in more frequent abnormal tracings than epidural analgesia (EA); however, the corresponding data related to dural puncture epidural (DPE) are unclear. We aimed to evaluate the rates of incidence of severe abnormal CTG after induction of DPE and CSEA.

METHODS

In this study of nulliparous women with full-term pregnancy, data for the DPE intervention group were prospectively collected, while those for the CSEA control group were obtained from medical records. Neuraxial analgesia was performed with cervical dilation ≤ 5 cm, administering initial epidural dosing of 15 mL of 0.125% levobupivacaine with fentanyl 2.5µg/mL for DPE, and intrathecal 0.5% bupivacaine 2.5 mg (0.5ml), fentanyl 10 µg (0.2ml), and 1.3 mL of saline for CSEA. The primary outcome was the incidence of PD, defined as a fetal heart rate reduction ≥ 15 bpm below the baseline and with a lowest value < 80 bpm, and lasting for ≥ 2 min but < 10 min (fetal heart rate < 80 bpm does not have to last for ≥ 2 min), within 90 min after induction of neuraxial labor analgesia.

RESULTS

A total of 302 patients were analyzed, with 151 in each group. The incidence of PD after DPE induction was significantly lower than that after CSEA induction (4.0% vs. 14.6%, P = 0.0015, odds ratio = 0.243, 95% confidence interval = 0.095-0.617).

CONCLUSION

DPE appears to be a safer method compared to CSEA for neuraxial labor analgesia in the early stages of labor for nulliparous women.

TRIAL REGISTRATION

UMIN-CTR: UMIN000035153 . Date registered: 01/01/2019.

摘要

背景

椎管内分娩镇痛后可能出现异常胎心监护（CTG）描记。严重异常的胎心监护，如长时间减速（PD）或心动过缓，提示胎儿状况不佳（NRFS），可能需要立即行剖宫产术。与硬膜外镇痛（EA）相比，蛛网膜下腔-硬膜外联合镇痛（CSEA）更常导致异常胎心监护，但与硬脊膜外穿刺硬膜外（DPE）相关的数据尚不清楚。我们旨在评估 DPE 和 CSEA 诱导后严重异常 CTG 的发生率。

方法

本研究纳入初产妇足月妊娠患者，DPE 干预组的数据为前瞻性收集，CSEA 对照组的数据来自病历。在宫颈扩张≤5cm 时行椎管内镇痛，DPE 初始硬膜外给予 15ml 0.125%左旋布比卡因+2.5µg/ml 芬太尼，CSEA 行蛛网膜下腔给予 0.5%布比卡因 2.5mg（0.5ml）+芬太尼 10µg（0.2ml）+1.3ml 生理盐水。主要结局是 PD 的发生率，定义为胎心下降≥15bpm，低于基线，最低值<80bpm，持续≥2min，但<10min（胎心<80bpm 不必持续≥2min），在椎管内分娩镇痛诱导后 90min 内发生。