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程序化间歇硬膜外推注作为分娩镇痛的理想方法：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：严旭 编辑：杨荣峰 审校：曹莹
尽管程序化间歇硬膜外推注（PIEB）在分娩镇痛中效果显著，但尚未确立适当的注药速率。因此，本研究探讨了不同硬膜外注药速率下的镇痛效果。
随机试验招募了计划自然分娩的初产妇。患者在硬膜外注射0.2%罗哌卡因3 mg联合芬太尼20 μg后，随机分为三组。硬膜外镇痛药物（0.2%罗哌卡因60 ml、芬太尼180 μg和0.9%生理盐水40 ml）通过病人自控硬膜外镇痛（PCEA）的方式给药：连续组（n = 28，10 ml/h持续输注）、PIEB组（n = 29，以240 ml/h的流速推注10 ml）和手动组（n = 28，以1200 ml/h的流速推注10 ml）。主要观察指标为每小时硬膜外镇痛液的消耗量，次要观察指标为从开始镇痛到首次爆发性疼痛的时间间隔。
三组之间每小时硬膜外麻醉药物的中位数消耗量（Q1, Q3）显著不同（连续组：14.3 [8.7, 16.9] ml，PIEB组：9.4 [6.2, 9.8] ml，手动组：8.6 [7.6, 9.9] ml；P < 0.001）。PIEB组镇痛时间显著长于其他两组（连续组：78.5 [35.8, 185.0] 分钟，PIEB组：200.0 [88.5, 441.5] 分钟，手动组：60.5 [37.3, 162.0] 分钟，P = 0.027）。
PIEB以低流速提供了比连续硬膜外输注或高流速手动推注更充分的分娩镇痛效果。
原始文献来源：Kim D, Kim J, Choo H, et,al. Programmed intermittent epidural bolus as an ideal method for labor analgesia: a randomized controlled trial[J]. Korean J Anesthesiol. 2024 Feb;77(1):106-114. doi: 10.4097/kja.23173.
Programmed intermittent epidural bolus as an ideal method for labor analgesia: a randomized controlled trial
Abstract
Background: Although programmed intermittent epidural bolus (PIEB) is effective for labor analgesia, an appropriate flow rate has not been established. Therefore, we investigated the analgesic effect based on different epidural injection flow rates.
Methods: Nulliparous women scheduled for spontaneous labor were enrolled in this randomized trial. After injection of intrathecal 0.2% ropivacaine 3 mg with fentanyl 20 μg, participants were randomized to three study groups. Epidural analgesics, 10 ml during one hour, were administered with patient controlled epidural analgesia as follows (0.2% ropivacaine 60 ml, fentanyl 180 μg, and 0.9% saline 40 ml): continuous (n = 28, 10 ml/h for continuous infusion), PIEB (n = 29, 240 ml/h for bolus infusion of 10 ml), or manual (n = 28, 1200 ml/h for bolus injection of 10 ml). The primary outcome was hourly consumption of the epidural solution. The time interval between labor analgesia and the first breakthrough pain was investigated.
Results: The median (Q1, Q3) hourly consumption of epidural anesthetics was significantly different among the groups (continuous: 14.3 [8.7, 16.9] ml, PIEB: 9.4 [6.2, 9.8] ml, manual: 8.6 [7.6, 9.9] ml; P < 0.001). The time to breakthrough pain for the PIEB group was longer than that for the other groups (continuous: 78.5 [35.8, 185.0] min, PIEB: 200.0 [88.5, 441.5] min, manual: 60.5 [37.3, 162.0] min, P = 0.027).
Conclusions: PIEB, with a low-flow rate, provided more adequate labor analgesia than a continuous epidural infusion or manual injection with a high-flow rate.
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