25G Whitacre针用于硬脊膜穿破硬膜外阻滞在分娩镇痛中有效性和安全性的meta分析

doi:10.20047/j.issn1673-7210.2023.07.25

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摘要目的评价应用25G Whitacre针的硬脊膜穿破硬膜外阻滞（DPE）在分娩镇痛中的有效性和安全性。方法计算机检索PubMed、Embase、The Cochrane Library、Web of Science、CNKI、万方数据库、VIP、中国生物医学文献数据库，搜集建库至2022年7月中有关25G Whitacre针的DPE应用于分娩镇痛的随机对照试验（RCT）。对文献进行筛选、资料提取及质量评价，采用RevMan 5.3软件行meta分析。结果共纳入11篇RCT，涉及1 678名产妇，硬膜外阻滞（EP）组、DPE组，各839名。meta分析结果显示，DPE组不对称阻滞发生率（OR=0.31，95%CI：0.21～0.47，P＜0.000 01）、镇痛不全发生率（OR=0.49，95%CI：0.36～0.67，P＜0.000 01）及使用丁哌卡因的运动阻滞发生率（OR=0.38，95%CI：0.18～0.81，P=0.01）均低于EP组，双侧感觉阻滞平面至S2水平发生率（OR=19.61，95%CI：8.22～46.78，P＜0.000 01）高于EP组。两组第一、二产程持续时间及剖宫产率、阴道器械助产率、新生儿1 min的Apgar评分、新生儿1 min Apgar评分＜7分发生率比较，差异无统计学意义（P＞0.05）。两组产妇低血压、头痛、瘙痒、使用罗哌卡因的运动阻滞发生率及胎心减慢发生率比较，差异无统计学意义（P＞0.05）。结论与EP比较，应用25G Whitacre针的DPE可以改善分娩镇痛效果，不增加产妇和新生儿不良反应发生率。

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	李晶于飞张全意赵立芳

关键词 ：硬脊膜穿破硬膜外阻滞, 硬膜外阻滞, 分娩镇痛, meta分析, 随机对照试验

Abstract：Objective To assess the efficacy and safety of dural puncture epidural block (DPE) with 25G Whitacre needle for labor analgesia. Methods The PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, China Biology Medicine disc were searched by computer, randomized controlled trials (RCT) of DPE with 25G Whitacre needle for labor analgesia were collected from inception to July 2022. Literature screening, data extraction, and quality evaluation were performed, and meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCT were included, involving 1 678 puerperas, including 839 puerperas in epidural block (EP) group and 839 puerperas in DPE group. Meta-analysis showed that the incidence of asymmetric block (OR=0.31, 95%CI: 0.21-0.47, P＜0.000 01), the incidence of analgesia insufficiency (OR=0.49, 95%CI: 0.36-0.67, P＜0.000 01), and incidence of motor block with Marcaine (OR=0.38, 95%CI: 0.18-0.81, P=0.01) were lower than those in EP group, and the incidence of bilateral sensory block plane to S2 level (OR=19.61, 95%CI: 8.22-46.78, P＜0.000 01) was higher than that in EP group. There were no significant differences in the duration of the first and second stages of labor, the rate of cesarean section, the rate of vaginal instrument assisted delivery, the Apgar score of newborns within 1 min, and the incidence of Apgar score＜seven points of newborns within 1 min between the two groups (P＞0.05). There were no significant differences in the incidence of hypotension, headache, pruritus, motor block with Ropivacaine in puerperas, and incidence of fetal heart slowdown between the two groups (P＞0.05). Conclusion Compared with EP, DPE with 25G Whitacre needle can improve the analgesic effect of labor and does not increase the incidence of maternal and neonatal adverse reactions.

Key words： Dural puncture epidural block Epidural block Labor analgesia Meta-analysis Randomized controlled trial

基金资助:国家自然科学基金青年科学基金资助项目（819 00269）；
山东省省级临床重点专科学科建设项目（SLCZDZ K-20麻醉科）。

通讯作者: 赵立芳（1986-），女，硕士；研究方向：妇产科麻醉。

作者简介: 李晶（1988-），女，硕士；研究方向：妇产科麻醉。

引用本文:

李晶于飞张全意赵立芳. 25G Whitacre针用于硬脊膜穿破硬膜外阻滞在分娩镇痛中有效性和安全性的meta分析[J]. 中国医药导报, 2023, 20(7): 114-118.
LI Jing YU Fei ZHANG Quanyi ZHAO Lifang. Meta-analysis on the efficacy and safety of dural puncture epidural block with 25G Whitacre needle for labor analgesia. 中国医药导报, 2023, 20(7): 114-118.

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[1] Nanji JA，Carvalho B. Pain management during labor and vaginal birth [J]. Best Pract Res Clin Obstet Gynaecol，2020， 67：100-112.
[2] Cappiello E，O’Rourke N，Segal S，et al. A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia [J]. Anesth Analg，2008，107（5）：1646-1651.
[3] Gunaydin B，Erel S. How neuraxial labor analgesia differs by approach：dural puncture epidural as a novel option [J]. J Anesth，2019，33（1）：125-130.
[4] Thomas JA，Pan PH，Harris LC，et al. Dural puncture with a 27-gauge Whitacre needle as part of a combined spinal- epidural technique does not improve labor epidural catheter function [J]. Anesthesiology，2005，103（5）：1046-1051.
[5] Cumpston M，Li T，Page MJ，et al. Updated guidance for trusted systematic reviews：a new edition of the Cochrane Handbook for Systematic Reviews of Interventions [J]. Cochrane Database Syst Rev，2019，10：ED000142.
[6] Song Y，Du W，Zhou S，et al. Effect of Dural Puncture Epidural Technique Combined With Programmed Intermittent Epidural Bolus on Labor Analgesia Onset and Maintenance：A Randomized Controlled Trial [J]. Anesth Analg，2021，132（4）：971-978.
[7] Wang J，Zhang L，Zheng L，et al. A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia [J].Ann Palliat Med，2021，10（1）：404-414.
[8] 晏明，张玉凤，崔恩惠，等.硬脊膜穿破硬膜外阻滞在分娩镇痛中的应用[J].国际麻醉学与复苏杂志，2020，41（8）：763-768.
[9] 晏明，王巧，张玉凤，等.程控间歇硬膜外脉冲输注模式下硬脊膜穿破硬膜外阻滞在分娩镇痛中的应用[J].国际麻醉学与复苏杂志，2021，42（9）：918-923.
[10] Gupta D，Srirajakalidindi A，Soskin V. Dural puncture epidural analgesia is not superior to continuous labor epidural analgesia [J]. Middle East J Anaesthesiol，2013，22（3）：309-316.
[11] 雷云龙，刘馨，张望，等.DPE、CSE、EP阻滞用于分娩镇痛的效果比较[J].中国计划生育学杂志，2021，29（6）：1172-1175.
[12] Bakhet WZ. A randomized comparison of epidural，dural puncture epidural，and combined spinal-epidural without intrathecal opioids for labor analgesia [J]. J Anaesthesiol Clin Pharmacol，2021，37（2）：231-236.
[13] 王菁，肖培汉，方团芳，等.硬脊膜穿破硬膜外阻滞联合程控间歇脉冲注入技术用于分娩镇痛的效果[J].中华麻醉学杂志，2021，41（6）：711-714.
[14] 赵丽斌，杨红艳，李长红，等.评估引导下不同穿刺技术对初产妇智能化病人自控镇痛分娩镇痛效应的影响[J].广东医学，2020，41（11）：1134-1138.
[15] Chau A，Bibbo C，Huang CC，et al. Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques：A Randomized Clinical Trial [J]. Anesth Analg，2017，124（2）：560-569.
[16] Guasch E，Brogly N，Gilsanz F. Combined spinal epidural for labour analgesia and caesarean section：indications and recommendations [J]. Curr Opin Anaesthesiol，2020，33：284-290.
[17] Yadav P，Kumari I，Narang A，et al. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida [J]. J Obstet Anaesth Crit Care，2018，8：24-28.
[18] Jadon A，Srivastawa S，Sinha N，et al. A pilot study comparing dural puncture epidural with 27G Whitacre needle and conventional lumbar epidural labor analgesia [J]. Ain- Shams J Anesthesiol，13，66（2021）.
[19] Layera S，Bravo D，Aliste J，et al. A systematic review of DURAL puncture epidural analgesia for labor [J]. J Clin Anesth，2019，53：5-10.
[20] 刘志强.椎管内分娩镇痛的技术进展和热点问题[J].同济大学学报（医学版），2020，41（6）：677-682.
[21] 潘秀红，段宏伟.硬脊膜穿破硬膜外阻滞联合程控硬膜外间歇脉冲给药在分娩镇痛中的应用[J].海南医学，2021，32（9）：1132-1135.
[22] 左美娟，张博，叶斌，等.硬膜外间歇脉冲注入技术用于分娩镇痛的效果[J].临床麻醉学杂志，2020，36（12）：1182- 1185.
[23] 宋玉洁，徐振东，刘志强.硬脊膜穿破硬膜外阻滞技术在分娩镇痛中的研究进展[J].国际麻醉学与复苏杂志，2019（2）：171-174.
[24] 徐晶晶，刘进.硬脊膜穿破硬膜外阻滞在无痛分娩中的发展及应用现状[J].实用医院临床杂志，2022，19（2）：174-177.
[25] 闫战秋，宋宝杰，吕小静，等.硬脊膜穿破硬膜外阻滞镇痛在肥胖产妇分娩中的应用观察[J].山东医药，2021， 61（18）：48-51.
[26] Heesen M，Rijs K，Rossaint R，et al. Dural puncture epidural versus conventional epidural block for labor analgesia：a systematic review of randomized controlled trials [J]. Int J Obstet Anesth，2019，40：24-31.
[27] 吴演文，徐波.硬脊膜穿破硬膜外阻滞技术用于分娩镇痛效果及对母婴影响[J].中国计划生育学杂志，2022， 30（1）：89-93，97.
[28] Segal S，Pan PH. Dural Puncture Epidural for Labor Analgesia：Is It Really an Improvement over Conventional Labor Epidural Analgesia [J]. Anesthesiology，2022，136（5）：667- 669.
[29] McClellan KJ，Faulds D. Ropivacaine：an update of its use in regional anaesthesia [J]. Drugs，2000，60（5）：1065-1093.