探讨硬脊膜穿破硬膜外阻滞(DPE)在产妇分娩镇痛中的镇痛效果、阻滞特征及不良反应。

选择2025年6月1日至12月31日万源市人民医院收治进入产程并拟接受椎管内分娩镇痛的135例单胎妊娠产妇为研究对象。采用随机数字表法，将其分为DPE组(n＝43)、硬膜外阻滞(EP)组(n＝47)和腰硬联合阻滞(CSE)组(n＝45)。比较3组产妇给药后连续6次宫缩情况(宫缩压力、宫缩持续时间及宫缩间隔)；镇痛后5、10、20、30 min的疼痛视觉模拟量表(VAS)评分及下肢运动阻滞情况(改良Bromage评分)；患者自控硬膜外镇痛(PCEA)有效按压次数、镇痛时长、镇痛药液使用总量、产程时长、麻醉和产科干预情况、满意度评分、分娩镇痛相关不良事件，以及分娩新生儿的Apgar评分和动脉血气分析结果。本研究遵循的程序符合万源市人民医院医学伦理委员会规定，并经过该伦理委员会批准(审批文号：LLSC-KY-202201)。所有受试者均签署阴道试产、椎管内麻醉分娩镇痛及临床研究知情同意书。

①3组产妇年龄、体重、身高等一般资料比较，差异均无统计学意义(P>0.05)。②镇痛效果：镇痛后5、10、20、30 min，3组产妇的VAS评分总体比较，差异均有统计学意义(P<0.05)；进一步两两比较结果显示，上述各时间点CSE组VAS评分均低于EP组和DPE组，DPE组VAS评分均低于EP组，并且差异均有统计学意义(P<0.017)。③宫缩相关指标：3组产妇给药后第3、5、6次宫缩压力及第1、3次宫缩间隔时间总体比较，差异均有统计学意义(P<0.05)；进一步两两比较结果显示，第3、6次宫缩压力，CSE组均低于EP组和DPE组，第5次宫缩压力，DPE组高于EP组和CSE组，第1次宫缩间隔时间，CSE组短于EP组和DPE组，第3次宫缩间隔时间，DPE组长于EP组和CSE组，并且差异均有统计学意义(P<0.017)；3组产妇连续6次宫缩持续时间分别总体比较，差异均无统计学意义(P>0.05)。④分娩镇痛相关指标及产程：3组产妇PCEA有效按压次数、镇痛时长、镇痛药液使用总量及第一、第二、第三产程时长分别比较，差异均无统计学意义(P>0.05)。⑤下肢运动阻滞：镇痛后5、10 min时，CSE组改良Bromage评分高于EP组和DPE组，镇痛后20 min时，CSE组改良Bromage评分高于EP组，差异均有统计学意义(P<0.017)。⑥不良事件及干预情况：3组产妇低血压、发热、皮肤瘙痒等不良事件发生率及麻醉干预率分别比较，差异均无统计学意义(P>0.05)；胎儿胎心异常发生率及产科干预率分别总体比较，差异有统计学意义(P<0.05)，但是进一步两两比较结果显示，差异均无统计学意义(P>0.017)。⑦3组产妇满意度评分及新生儿生后1、5、10 min Apgar评分、脐动脉血气分析指标分别总体比较，差异均无统计学意义(P>0.05)。

DPE用于分娩镇痛可改善EP早期镇痛不足，并较CSE表现出较轻的早期下肢运动阻滞，亦未增加母婴不良反应发生风险。DPE在产妇分娩镇痛效果、运动功能保留及母婴安全性方面具有一定优势，可为椎管内分娩镇痛方式的选择提供参考。

To investigate the analgesic efficacy, block characteristics, and adverse reactions of dural puncture epidural (DPE) for labor analgesia.

A total of 135 parturients with singleton pregnancies who entered labor and planned to receive neuraxial labor analgesia at Wanyuan People′s Hospital from June 1 to December 31, 2025 were selected into this study. They were assigned to DPE group (n=43), epidural analgesia (EP) group (n=47) and combined spinal-epidural analgesia (CSE) group (n=45) using a random number table method. The following outcomes were compared among the three groups: uterine contraction parameters during six consecutive contractions after drug administration, including uterine contraction pressure, contraction duration, and contraction interval; visual analogue scale (VAS) scores and lower-limb motor block, assessed by the modified Bromage score, at 5, 10, 20, and 30 min after analgesia; the number of effective patient-controlled epidural analgesia (PCEA) bolus attempts, duration of analgesia, total consumption of analgesic solution, duration of labor stages, anesthesia and obstetric interventions, maternal satisfaction score, labor analgesia-related adverse events, neonatal Apgar scores, and arterial blood gas analysis results. The procedures of this study complied with the regulations of the Medical Ethics Committee of Wanyuan People′s Hospital and were approved by the committee (Approval No. LLSC-KY-202201). All participants signed informed consent forms for trial of vaginal delivery, neuraxial labor analgesia, and participation in this clinical study.

①There were no statistically significant differences in general characteristics, including maternal age, body weight, and height, among the three groups (P>0.05). ② In terms of analgesic efficacy, there were statistically significant differences in the overall comparison of VAS scores among the three groups at 5, 10, 20, and 30 min after analgesia (P<0.05). Further pairwise comparisons showed that, at each time point, VAS scores in the CSE group were lower than those in the EP and DPE groups, and VAS scores in the DPE group were lower than those in the EP group, with statistically significant differences (P<0.017). ③In terms of uterine contraction-related parameters, there were statistically significant differences in the overall comparisons of the 3rd, 5th, and 6th uterine contraction pressures and the 1st and 3rd uterine contraction intervals after drug administration among the three groups (P<0.05). Further pairwise comparisons showed that the 3rd and 6th uterine contraction pressures were lower in the CSE group than those in the EP and DPE groups; the 5th uterine contraction pressure was higher in the DPE group than that in the EP and CSE groups; the 1st uterine contraction interval was shorter in the CSE group than that in the EP and DPE groups; and the 3rd uterine contraction interval was longer in the DPE group than that in the EP and CSE groups, with statistically significant differences (P<0.017). There were no statistically significant differences in the overall comparisons of the durations of six consecutive uterine contractions among the three groups (P>0.05). ④In terms of labor analgesia-related parameters and labor duration, there were no statistically significant differences in the number of effective PCEA bolus attempts, duration of analgesia, total consumption of analgesic solution, or durations of the first, second, and third stages of labor among the three groups (P>0.05). ⑤In terms of lower-limb motor block, the modified Bromage scores in the CSE group were higher than those in the EP and DPE groups at 5 and 10 min after analgesia, and higher than those in the EP group at 20 min after analgesia, with statistically significant differences (P<0.017). ⑥In terms of adverse events and interventions, there were no statistically significant differences in the incidences of maternal hypotension, fever, pruritus, or anesthesia intervention among the three groups (P>0.05). There were statistically significant differences in the overall comparisons of the incidence of fetal heart rate abnormalities and the rate of obstetric intervention (P<0.05); however, further pairwise comparisons showed no statistically significant differences (P>0.017). ⑦There were no statistically significant differences in maternal satisfaction scores, neonatal Apgar scores at 1, 5, and 10 min after birth, or arterial blood gas analysis results among the three groups (P>0.05).

DPE for labor analgesia can improve the early analgesic efficacy of EP and is associated with less early lower-limb motor block than CSE, without increasing the risk of maternal and neonatal adverse events. DPE has certain advantages in analgesic efficacy, preservation of motor function, and maternal and neonatal safety, and may provide a reference for the selection of neuraxial labor analgesia techniques.