上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2020, Vol. 40 ›› Issue (2): 219-.doi: 10.3969/j.issn.1674-8115.2020.02.012

• 论著·临床研究 • 上一篇    下一篇

改良硬膜外导管用于分娩镇痛的临床研究

徐 韬，郑 静，安小虎   

  1. 上海交通大学医学院附属国际和平妇幼保健院麻醉科，上海市胚胎源性疾病重点实验室，上海200030
  • 出版日期:2020-02-28 发布日期:2020-03-20
  • 通讯作者: 郑 静，电子信箱：Sukura5203yy@sjtu.edu.cn。
  • 作者简介:徐 韬（1981—），男，主治医师，硕士；电子信箱：towerxutao@163.com。
  • 基金资助:
    上海市临床重点专科（建设项目）-“强主体”妇产科项目；上海申康医院发展中心临床科技创新项目（SHDC12016225）。

Clinical research of improved epidural catheter used in labor analgesia

XU Tao, ZHENG Jing, AN Xiao-hu   

  1. Shanghai Key Laboratory of Embryo Original Diseases, Department of Anesthesiology, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2020-02-28 Published:2020-03-20
  • Supported by:
    Project of Shanghai Municipal Key Clinical Specialty; Clinical Science and Technology Innovation Program of Shanghai Hospital Development Center (SHDC12016225).

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摘要： 目的·探索分娩镇痛中使用改良硬膜外导管的可行性。方法·选择2018年1—8月于上海交通大学医学院附属国际和平妇幼保健院自然分娩并要求行分娩镇痛的产妇144例，随机将其分为3组；其中在硬膜外分娩镇痛中，A组产妇使用改良硬膜外导管进行硬膜外腔置管，B组产妇使用Arrow FlexTip Plus硬膜外导管置管，C组产妇（对照组）使用普通硬膜外导管置管。记录3组产妇的硬膜外血管损伤和血管内置管、神经异感、蛛网膜下腔置管、单侧阻滞、困难置管、多次置管、置管阻力消失感、拔管困难和导管损坏的发生率。采用Fisher确切概率法比较上述指标间的差异，然后用Dunnett t检验对3组间有显著差异的指标进行两两比较。同时，观察B、C组中需要使用改良硬膜外导管再次置管的病例数及统计其成功率。结果·与C组相比，A组产妇的硬膜外血管损伤和血管内置管的发生率（P0.002）、困难置管的发生率（P0.000）、多次置管的发生率（P0.006）均有所下降。且与B组、C组相比，A组产妇的置管阻力消失感发生率亦有所下降（P0.021，P0.000）。结论·相较于普通硬膜外导管，改良硬膜外导管能有效降低硬膜外血管损伤和血管内置管、困难置管及置管阻力消失感的发生率，提高多次置管的成功率，具有潜在的临床应用价值。

关键词: 硬膜外导管, 分娩镇痛, 硬膜外阻滞并发症

Abstract:

Objective · To explore the clinical feasibility of a new kind of improved epidural catheter used in labor analgesia. Methods · A total of 144 patients who were spontaneous labor and required epidural labor analgesia Jan. to Aug. 2018 in the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine were selected, and randomly divided into three groups. The improved epidural catheters were used in epidural catheterization in group A, the Arrow FlexTip Plus epidural catheters were used in group B, and the conventional epidural catheters were used in group C (control group). The incidences of epidural venous injuries and intravascular insertion, paresthesia, subarachnoid insertion, unilateral block, difficult insertion, repeated re-insertion, loss of resistance feeling, difficult extubation and catheter damage in the three groups were recorded. Fisher exact test was used to compare the difference among the above indexes in the three groups, and then Dunnett t test was further used to compare the differential indicators between each two groups. Re-insertion with improved epidural catheter in group B and group C and its success rate were also recorded. Results · Compared with group C, the incidences of epidural venous injuries and intravascular insertion (P0.002), difficult insertion (P0.000) and repeated re-insertion (P0.006) in group A were decreased significantly. Compared with group B and group C, the incidence of loss of resistance feeling was also decreased significantly (P0.021，P0.000). Conclusion · Compared with the conventional epidural catheter, the improved epidural catheter can effectively reduce the incidence of epidural venous injuries and intravascular insertion, difficult insertion and loss of resistance feeling, and improve the success rate after repeated re-insertion, which has the potential value in clinical use.

Key words: epidural catheter, labor analgesia, complication of epidural analgesia