【摘要】 [背景]观察硬脊膜穿破硬膜外(DPE)阻滞技术在初产妇分娩镇痛中的应用效果.[病例报告]选择于2020年9月—2022年1月间收治的84例经阴道分娩且符合纳入标准的足月初产妇，按照随机数字表法分为2组，即对照组和观察组各42例.对照组施行腰-硬联合麻醉(CSEA)+患者自控硬膜外镇痛(PCEA),观察组施行PCEA+DPE阻滞，观察随访至产后48 h.比较两组产妇的镇痛起效时间、疼痛程度、新生儿情况及不良反应发生情况.结果显示，两组罗哌卡因用量、舒芬太尼用量及患者自控阵痛按压次数间差异均无统计学意义(P>0.05);观察组镇痛起效时间明显长于对照组(P<0.05);两组镇痛前(T0)、镇痛后5 min(T1)时的VAS评分间差异有统计学意义(P<0.05);两组镇痛后30 min(T2)、镇痛后60 min(T3)、宫口开至8 cm(T4)及分娩时(T5)的VAS评分间差异均无统计学意义(P>0.05).两组产程时间、胎儿娩出后1、5 min新生儿的Apgar评分、不良反应发生率及产妇满意率间差异均无统计学意义(P>0.05).[讨论] DPE阻滞用于初产妇分娩镇痛较为安全有效，但是否较CSEA更具有优势尚需进一步探讨.更多还原

【Abstract】 BACKGROUND To observe the analgesic effect of dural puncture epidural(DPE) block on primipara labor analgesia. CASE REPORT A total of 84 full-term primiparas who delivered vaginally and met the inclusion criteria were selected from September 2020 to January 2022, and divided into 2 group according to the random number table method, the control group and the observation group with 42 cases in each group. The control group was given combined spinal epidural anesthesia(CSEA)+patient-controlled epidural analgesia(PCEA), and the observation group was given PCEA+DPE block, observation was followed to 48 hours after delivery. The onset time of analgesia, degree of pain, neonatal condition and adverse reactions were compared between the two groups. The results showed that there was no significant difference in the dosage of ropivacaine and sufentanil and the times of patient-controlled analgesia compression between the two groups(P>0.05). The onset time of analgesia in the observation group was significantly longer than that in the control group(P<0.05). There were significant differences in VAS scores between the two groups before analgesia(T0) and at 5 min after analgesia(T1)(P<0.05). There was no significant difference in VAS scores between the two groups at 30 min after analgesia(T2), 60 min after analgesia(T3), cervical dilation to 8 cm(T4) and delivery(T5)(P>0.05). There was no significant difference in the duration of labor, Apgar scores at 1 and 5 minutes after delivery, the incidence of adverse reactions and maternal satisfaction between the two groups(P>0.05). DISCUSSION DPE block is safe and effective for labor analgesia in primipara, but whether it has more advantages than CSEA needs to be further explored.更多还原