Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100026, People's Republic of China.
Cell Mol Biol (Noisy-le-grand). 2024 Jun 5;70(6):37-41. doi: 10.14715/cmb/2024.70.6.6.
This work compared the effects of dural puncture epidural (DPE), combined spinal epidural analgesia (CSEA) and epidural analgesia (EA) on labor analgesia for primiparae and their impacts on maternal and infant safety. A total of 204 primiparae in need of labor analgesia for vaginal delivery were allocated to DPE, CSEA and EA groups. At 10 min, 30 min and 1 h after analgesia, the DPE and CSEA groups showed lower VAS scores and quicker onset of action than EA group. There was no significant difference in the duration of analgesia and labor and fetal decelerations among the 3 groups. At 1 min and 5 min after childbirth, the neonatal Apgar scores showed no significant difference between the 3 groups. The Bromage scores of DPE and EA groups were lower than those of CSEA group. The incidence of pruritus, hypotension, and postpartum headache in DPE and EA groups were lower than those in CSEA group. To sum up, the efficacy of DPE in labor analgesia for primiparae is similar to that of CSEA, with no obvious effect on labor stage and neonatal Apgar score, no additional complications and less LLMB, pruritus, hypotension and postpartum headache.
本研究比较了硬膜外穿刺联合硬膜外麻醉（DPE）、腰硬联合麻醉（CSEA）和硬膜外麻醉（EA）对初产妇分娩镇痛的效果及其对母婴安全性的影响。将 204 例需行阴道分娩分娩镇痛的初产妇分为 DPE 组、CSEA 组和 EA 组。镇痛后 10min、30min 和 1h，DPE 组和 CSEA 组的 VAS 评分均低于 EA 组，且起效更快。3 组的镇痛持续时间、产程和胎儿减速无明显差异。分娩后 1min 和 5min，3 组新生儿 Apgar 评分无明显差异。DPE 组和 EA 组的 Bromage 评分均低于 CSEA 组。DPE 组和 EA 组的瘙痒、低血压和产后头痛发生率均低于 CSEA 组。综上所述，DPE 用于初产妇分娩镇痛的效果与 CSEA 相似，对产程和新生儿 Apgar 评分无明显影响，无额外并发症，且下肢运动阻滞（LLMB）、瘙痒、低血压和产后头痛的发生率更低。
