Clinical Application Of Programmed Intermittent Epidural Bolus In Whole Stage Of Labor Analgesia

Objective To explore the safety and effectiveness of programmed intermittent epidural bolus in whole stage of Labor Analgesia.Methods A prospective,randomized clinical study was conducted to select pregnant and lying-in women who were hospitalized in Anhui Maternal and Child Health Hospital from January 2017 to December 2017.According to different methods of epidural analgesia,there were randomly divided into two groups as the study group : programmed intermittent epidural bolus(PIEB)combined with PCEA or continuous epidural infusion(CEI)combined with PCEA.while those who did not implement labor analgesia at the same time were used as the control group.There were 1218 cases of pregnant and lying-in women in CEI group,1057 cases in PIEB group and 680 cases in control group.The study was approved by the Medical Ethics Committee of Anhui Maternal and Child Health Hospital.All the mothers and their families involved in the experiment were aware of and signed the medical-related informed consent.The study was approved by the Medical Ethics Committee of Anhui Maternal and Child Health Hospital.All the mothers and their families involved in the experiment were aware of and signed the medical-related informed consent.The clinical datas were collected and analyzed by SPSS 23.0 software.All normal clinical measurements were expressed as mean(x±s).Inter-group comparisons were performed by one-way ANOVA,followed by two-way comparisons with SNK-q.The measurements of skewed distribution were expressed as median(quartile spacing)and Kruskal-Wallish test was used forinter-group comparison.The difference was statistically significant with P < 0.05.Results1.Analgesic effect: The VAS scores of 5 minutes(T2),15 minutes(T3),30 minutes(T4),60 minutes(T5)and after delivery(T6)in PIEB group were significantly lower than those in CEI group(P<0.05).The maternal satisfaction score of PIEB group was significantly higher than that of CEI group(P<0.05),and the improved Bromage score of each time point of the two groups was zero.2.Pregnancy outcome: There was no significant difference in cesarean section rate among the three groups(P>0.05),and there was significant difference between normal labor and forceps rate(P<0.05).There was no statistical difference among the first stage of labor,the third stage of labor and the total stage of labor(P>0.05).The second stage of labor in PIEB group was significantly shorter than that in CEI group(P<0.05).There were significant differences in the amount of intrapartum hemorrhage and total hemorrhage among the three groups(P<0.05).The Apgar scores of 1 minute and 5minute neonates in the three groups were above 8.3.Use of anesthetics: There were significant differences in total use of anesthetics,ropivacaine and sufentanil in the study group(P<0.05).4.Postpartum complications: There were no motor block,nausea,vomiting and hypotension in the two groups.There were 112(9.20%)cases of fever in CEI,and 95cases(8.99%)in PIEB group.,but there was no significant difference between the two groups(P>0.05).Conclusions1.On the basis of relatively large sample size,the results of comparison among the three groups show that the two analgesic methods of PIEB combined with PCEA and CEI combined with PCEA can achieve satisfactory analgesic effect.2.Compared with CEI group,PIEB group had better analgesic effect,which couldimprove maternal satisfaction and reduce the impact on the second stage of labor.3.Reduce the use of narcotic drugs and will not lead to increased incidence of hypotension,vomiting and other adverse reactions,the overall safety of mothers and infants will not be adversely affected.4.programmed intermittent epidural bolus can be safely and effectively applied to obstetric delivery analgesia,and will have a good application market prospect in the future medical development.