天津医药

天津医药 ›› 2023, Vol. 51 ›› Issue (10): 1146-1152.doi: 10.11958/20230652

• 药物临床观察 • 上一篇    

不同剂量1.5%氯普鲁卡因缓解分娩镇痛爆发痛的效果

计天珍1(), 徐成2, 刘红霞1, 李国防1, 李锐3, 朱海娟1,△()   

  1. 1.安徽省妇幼保健院麻醉科（邮编230011）
    2.上海交通大学附属第六人民医院麻醉科
    3.安徽医科大学第二附属医院麻醉与围术期医学科
  • 收稿日期:2023-05-04 修回日期:2023-05-19 出版日期:2023-10-15 发布日期:2023-10-18
  • 通讯作者: ∆E-mail：35880762@qq.com
  • 作者简介:计天珍（1987），女，副主任医师，主要从事产科分娩镇痛、产科危重症麻醉方面研究。E-mail：happy_tianzhen@126.com
  • 基金资助:
    国家自然科学基金资助项目(82100315)

Effect of epidural injection with different doses of 1.5% chloroprocaine in relieving breakthrough pain during labor analgesia

JI Tianzhen1(), XU Cheng2, LIU Hongxia1, LI Guofang1, LI Rui3, ZHU Haijuan1,△()   

  1. 1. Department of Anesthesiology, Anhui Provincial Maternal and Child Health Hospital, Hefei 230011, China
    2. Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital
    3. Department of Anesthesiology and Perioperative Medicine, the Second Hospital of Anhui Medical University
  • Received:2023-05-04 Revised:2023-05-19 Published:2023-10-15 Online:2023-10-18
  • Contact: ∆E-mail：35880762@qq.com

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摘要：

目的 探讨1.5%氯普鲁卡因硬膜外注射量缓解分娩镇痛中爆发痛的效果。方法 选择硬膜外麻醉分娩镇痛后出现爆发痛的初产妇128例，随机分为R组、C1组、C2组和C3组。出现爆发痛时，R组硬膜外注射0.15%罗哌卡因6 mL，C1组、C2组、C3组硬膜外分别注射1.5%氯普鲁卡因6、8、10 mL。给药后每隔3 min对产妇进行1次疼痛视觉模拟评分（VAS）评估镇痛效果。记录主要观察指标：爆发痛给药起效时间和爆发痛治疗的成功率。次要观察指标：补救镇痛率；产妇满意度（爆发痛给药后5 min、胎儿娩出后24 h）；首次爆发痛发生时（T0）、给药后3 min（T1）、6 min（T2）、9min（T3）、12 min（T4）、15 min（T5）、18 min（T6）的疼痛VAS、改良Bromage评分、胎心率（FHR）；爆发痛时、给药后第2、4、6、8、10、12次宫缩的间隔和持续时间；1、5 min时Apgar评分；不良反应。结果 Kaplan-Meier曲线结果显示R组、C1组、C2组、C3组爆发痛给药后的中位起效时间（95%CI）分别为14.3（13.4~15.2）min、6.6（5.6~7.6）min、5.9（5.0~6.8）min和4.7（3.9~5.4）min，C3组爆发痛给药起效时间快于C1组（Log-rank χ2为9.852，P<0.05 ）和C2组（Log-rank χ2为5.325，P<0.05 ）。与R组比，C2、C3组爆发痛治疗成功率、爆发痛给药后5 min和胎儿娩出后24 h的产妇满意度升高，C3组补救镇痛率下降（P<0.01）；与C1组比，C3组爆发痛治疗成功率升高，补救镇痛率下降，C2、C3组爆发痛给药后5 min和胎儿娩出后24 h的产妇满意度提高（P<0.01）。T1时，C2、C3组疼痛VAS低于R组，C3组低于C1组（P<0.05）；T2—5时，C1、C2、C3组疼痛VAS低于R组，C2、C3组疼痛VAS低于C1组（P<0.05）；T6时，C2、C3组疼痛VAS显著低于R和C1组（P<0.05）。4组宫缩间隔时间、宫缩持续时间差异无统计学意义。与R组和C1组相比，C3组爆发痛给药30 min内下肢麻木发生率升高（P<0.05）。4组间改良Bromage评分、爆发痛给药前后不同时点FHR、1、5 min时Apgar评分差异无统计学意义。结论 硬膜外注射1.5%氯普鲁卡因治疗分娩镇痛中爆发痛的最佳有效剂量为8 mL。

关键词: 分娩疼痛, 爆发性疼痛, 镇痛, 产科, 镇痛, 硬膜外, 氯普鲁卡因, 起效时间

Abstract:

Objective To investigate the effect of epidural injection of 1.5% chloroprocaine on breakthrough pain during labor analgesia. Methods A total of 128 primiparas with breakthrough pain after epidural labor analgesia were randomly divided into four groups (R, C1, C2 and C3 groups). When breakthrough pain occurred, 0.15% ropivacaine 6 mL was injected epidural in the group R, and 1.5% chloroprocaine 6, 8 and 10 mL were injected epidural in the group C1, the group C2 and the group C3, respectively. The visual analogue score (VAS) for pain was assessed every 3 minutes after the administration of local anesthetics. The primary outcome was recorded including the onset time of breakthrough pain after the administration and the success rate of breakthrough pain treatment. Secondary outcome included rescue analgesia rate, maternal satisfaction (5 minutes after administration of breakthrough pain, 24 hours after the delivery), VAS, modified Bromage score, fetal heart rate (FHR) at first breakthrough pain (T0), 3 min (T1), 6 min (T2), 9min (T3), 12 min (T4), 15 min (T5) and 18 min (T6) after administration, the interval and duration of uterine contraction at the onset time of breakthrough pain, the second, fourth, sixth, eighth, tenth and twelfth contractions after administration, Apgar score in 1 and 5 min and adverse reactions. Results Kaplan-Meier survival analysis showed that the median onset time (95%CI) of breakthrough pain in the group R, the group C1, the group C2 and the group C3 were 14.3 (13.4-15.2) min, 6.6 (5.6-7.6) min, 5.9 (5.0-6.8) min and 4.7 (3.9-5.4) min, respectively. The onset time of administration was significantly faster in the group C3 than that in the group C1 and the group C2 (Log-rank χ2 was 9.852 and 5.325, P<0.05). Compared with the group R, the success rate of breakthrough pain treatment and maternal satisfaction (5 minutes after administration, 24 hours after the delivery) were significantly increased in the group C2 and the group C3, and remedial analgesia rate was significantly decreased in the group C3 (P < 0.01). Compared with the group C1, the success rate of breakthrough pain treatment was increased and the remedial analgesia rate was decreased in the group C3 Maternal satisfaction (5 minutes after administration, 24 hours after the delivery ) was significantly increased in the group C2 and the group C3 (P < 0.01). At T1, the VAS score was significantly lower in the group C2 and the group C3 than that in the group R, and which was significantly lower in the group C3 than that in the group C1 (P < 0.05). At T2~5, the VAS score was significantly lower in the group C1, the group C2 and the group C3 than that in the group R, and which was significantly lower in the group C2 and the group C3 than that in the group C1 (P < 0.05). At T6, VAS scores were significantly lower in the group C2 and the group C3 than those of the group R and the group C1 (P<0.05). There were no significant differences in the interval of uterine contractions and duration of uterine contractions between the four groups. Compared with the group R and the group C1, the probability of lower limb numbness within 30 minutes after administration of breakthrough pain was significantly higher in the group C3 (P<0.05). There were no significant differences in modified Bromage score, FHR at different time points before and after administration, and Apgar score at 1 and 5 min between the four groups. Conclusion The optimal effective dose of epidural injection of 1.5% chloroprocaine for the treatment of breakthrough pain during labor analgesia is 8 mL.

Key words: labor pain, breakthrough pain, analgesia, obstetrical, analgesia, epidural, chloroprocaine, onset time

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