Qin Junjun, Zhou Weili, Chen Zhengwei, He Changlin, Ma Jiasen
Doctor of Medicine, Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Head Nurse, Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Indian J Anaesth. 2025 Oct;69(10):999-1011. doi: 10.4103/ija.ija_802_25. Epub 2025 Sep 5.
This study aimed to systematically evaluate the effectiveness and safety of dural puncture epidural (DPE) and combined spinal epidural (CSE) for labour analgesia in parturients.
Searches were performed in PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Database, and CBM Database up to June 2025 to identify randomised controlled trials (RCTs) investigating the application of DPE and CSE techniques for labour analgesia in parturients. Data from eligible studies were pooled to calculate the combined standardised mean difference (SMD) or risk ratio (RR).
Eleven studies with 1461 parturients were included. DPE had higher visual analogue scale (VAS) pain scores at 10 min [SMD: 0.60; 95% confidence interval (CI): 0.24, 0.95; = 0.001; 76%] compared to CSE but fewer parturients requiring physician top-up boluses (RR = 0.64; 95% CI: 0.46, 0.88; = 0.006; 11%). It also showed significantly lower incidences of abnormal foetal heart rate patterns (RR = 0.27; 95% CI: 0.16, 0.44; < 0.001; 0%), pruritus (RR = 0.27; 95% CI: 0.14, 0.53; < 0.001; 54%), and maternal hypotension (RR = 0.36; 95% CI: 0.15, 0.89; = 0.030; 74%). No significant intergroup differences were found in first-stage labour duration, neonatal Apgar scores, or adverse reactions. The trial sequential analysis suggested the need for further data.
Compared with CSE, although DPE has a slower onset of analgesia, it may provide more reliable analgesic effects and result in lower incidence rates of adverse reactions in both parturients and foetuses. Substantial heterogeneity in some outcomes, driven by clinical heterogeneity including dose variations and limited studies, warrants cautious interpretation.
本研究旨在系统评价硬膜外穿刺硬膜（DPE）和腰麻-硬膜外联合阻滞（CSE）用于产妇分娩镇痛的有效性和安全性。
检索截至2025年6月的PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方数据库、维普数据库和中国生物医学文献数据库，以识别调查DPE和CSE技术用于产妇分娩镇痛的随机对照试验（RCT）。汇总符合条件研究的数据，计算合并标准化均数差（SMD）或风险比（RR）。
纳入11项研究，共1461例产妇。与CSE相比，DPE在10分钟时视觉模拟评分（VAS）疼痛评分更高[SMD：0.60；95%置信区间（CI）：0.24，0.95；P = 0.001；I² = 76%]，但需要医生追加推注的产妇较少（RR = 0.64；95%CI：0.46，0.88；P = 0.006；I² = 11%）。它还显示胎儿心率异常模式、瘙痒和产妇低血压的发生率显著更低（RR分别为0.27；95%CI：0.16，0.44；P < 0.001；I² = 0%；RR分别为0.27；95%CI：0.14，0.53；P < 0.001；I² = 54%；RR分别为0.36；95%CI：0.15，0.89；P = 0.030；I² = 74%）。第一产程时长、新生儿阿氏评分或不良反应方面未发现显著组间差异。试验序贯分析表明需要更多数据。
与CSE相比，尽管DPE镇痛起效较慢，但它可能提供更可靠的镇痛效果，并导致产妇和胎儿不良反应发生率更低。由于包括剂量变化和研究有限在内的临床异质性导致某些结果存在实质性异质性，因此解释结果时需谨慎。
