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一种创新的方法来确定用于分娩止痛的编程间歇性外周螺栓设置:一个随机对照试验

Allana Munro^1,2, Ronald B George³, Pantelis Andreou⁴

¹From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Anesthesia and analgesia

|June 21, 2024

概括

响应表面方法 (RSM) 优化了用于分娩止痛的编程间歇性外周止痛剂 (PIEB) 设置,平衡了母亲的满意度,临床医生的止痛剂使用和患者控制的外周止痛剂 (PCEA) 比率. 该研究确定了特定的PIEB设置,以实现这些同时临床目标.

科学领域:

麻醉学和疼痛管理
临床实践中的数学建模
产科疼痛缓解产科疼痛缓解

背景情况:

编程间歇性外周螺栓 (PIEB) 需要三个设置 (PIEB下一个螺栓,PIEB间隔,PIEB体积) 进行分娩止痛,但最佳设置仍未确定.
同时平衡多个患者的结果对于有效的分娩止痛至关重要.
该研究旨在解决缺乏确定的最佳PIEB参数的问题.

研究的目的:

使用响应表面方法 (RSM) 来估计最佳PIEB设置 (PIEBnb,PIEBi,PIEBv).
为了同时最大限度地提高孕产妇的满意度,最大限度地减少临床医生给出的球体,并优化患者控制的外周止痛疗法 (PCEA) 交付比率.
建立一个数学模型来优化复杂的产科止痛参数.

主要方法:

一个双盲随机试验在第三级护理劳动和分娩中心进行.
纳入标准侧重于无产妇患者 (ASA身体状况II,18-45岁) 在没有禁忌的自发分娩中.
用RSM来确定PIEB设置,以优化母亲的满意度 (视觉模拟尺度),PCEA比率和临床医生玻尿酸要求.

主要成果:

这项研究包括了69名患者.
从RSM获得的最佳PIEB设置是:PIEBnb = 29.4分钟,PIEBi = 59.8分钟,PIEBv = 6.2毫升.
这些设置产生了高的母亲满意度 (93.9%),PCEA比率为0.77,以及对临床医师玻尿酸剂的低需求 (0.29).

结论:

使用RSM的数学建模可以有效估计PIEB设置,同时解决多个临床结果在分娩止痛.
同时优化同等权重的结果可能与个体患者的优先事项不一致.
未来的研究应该探索RSM以针对产科止痛的具体,优先结果.

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