关键词: 分娩, 镇痛, 硬膜外, 发热, 程控硬膜外脉冲式注入, 连续硬膜外输注

Abstract: Objective　To investigate the effect of programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI) on fever during delivery. Methods　A total of 180 cases of full-term, singleton and head primiparous were selected and divided into PIEB group and CEI group according to the random number table method, with 90 cases in each group. Both groups used a loading dose (0.125% ropivacaine + 0.4 mg/L sufentanil) 10 mL, and the analgesic pump 0.08% ropivacaine + 0.4 mg/L sufentanil. Pulsed administration was started 30 minutes after the loading dose in PIEB group, with an interval of 30 minutes, and the pulsed dose was 10 mL/h. The CEI group was given the background dose continuously after the loading dose injection. In both groups, the amount of PCEA was 5 mL, and the lock time was 30 min. The visual analogue scale (VAS) and fever of uterine contraction pain were recorded before analgesia, 1, 2, 3, 4, and 5 hours after analgesia, during delivery, 1 hour and 2 hours after delivery in the two groups. At the same time, the maternal oxytocin usage during analgesia, labor time, analgesic time, artificial membrane rupture ratio, analgesic drug dosage, PCEA compression ratio, labor analgesic effect satisfaction score and adverse reactions were collected. The birth weight, Apgar score at 1 and 5 minutes after birth, and fever 1 hour after birth of newborn were recorded. Enzyme-linked immunosorbent assay (ELISA) was used to determine the serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) expression levels before analgesia, during delivery and 24 hours after delivery. Results　The VAS scores of pain at 1 to 5 hours after analgesia and during delivery were lower in the PIEB group than those in the CEI group (P＜0.05). The incidence of fever at 4 to 5 hours after analgesia, during delivery, 1 hour after delivery and 2 hours after delivery was significantly lower in the PIEB group than that in the CEI group (P＜0.05). The PCEA compression demand ratio and the total amount of epidural analgesics were significantly lower in the PIEB group than those in the CEI group, and the analgesic effect satisfaction score was significantly higher in the PIEB group than that of the CEI group (P＜0.05). The expression levels of serum IL-6 and TNF-α were significantly higher after delivery analgesia than before the analgesia in the two groups (P＜0.05), and the serum IL-6 and TNF-α expression levels were significantly lower during delivery and 24 hours after delivery in the PIEB group than those of the CEI group (P＜0.05). Conclusion　PIEB can reduce the incidence of fever during childbirth, reduce inflammation and have a good analgesic effect.

Key words: parturition, analgesia, epidural, fever, programmed intermittent epidural bolus, continuous epidural infusion