双侧阴部神经阻滞麻醉联合限制性会阴切开术的临床研究  

Application of bilateral pudendal nerve block combined with restrictive episiotomy in vaginal delivery

作　　者：蒋丹红[1] 樊雅静[1] JIANG Danhong;FAN Yajing(Department of Obstetrics&Gynecology,the Sixth People’s Hospital,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院妇产科,上海200233

出　　处：《上海医学》2020年第11期666-669,共4页Shanghai Medical Journal

摘　　要：目的探讨双侧阴部神经阻滞麻醉联合限制性会阴切开术应用于产妇经阴道分娩的临床效果。方法选择2018年4—12月在上海交通大学附属第六人民医院采用限制性会阴切开术助产的初产妇240例,随机分入研究组(行双侧阴部神经阻滞麻醉)和对照组(行单侧阴部神经阻滞麻醉),每组120例。比较两组产妇会阴裂伤情况,胎儿娩出时和产后2 h产妇疼痛VAS评分,以及产妇第二产程用时、产后出血量、产后尿潴留发生率和新生儿窒息发生率。结果研究组胎儿娩出时、产后2 h的产妇疼痛VAS评分为(2.2±0.8)、(1.9±0.4)分,分别显著低于对照组的(5.1±2.3)、(3.6±1.2)分(P值均<0.05)。研究组会阴裂伤发生率为60.0%(72/120),显著低于对照组的87.5%(105/120,P<0.05)。研究组第二产程时间(45.6±14.7)min,显著短于对照组的(69.5±15.2)min(P<0.05);产后出血量为(134.3±26.4)mL,显著少于对照组的(183.5±25.7)mL(P<0.05);产后尿潴留发生率和新生儿窒息发生率为2.5%(3/120)、1.7%(2/120),分别显著低于对照组的9.2%(11/120)、8.3%(10/120,P值均<0.05)。结论应用双侧阴部神经阻滞麻醉联合限制性会阴切开术能有效降低经阴道分娩的初产妇会阴裂伤发生率,减少产后出血,并有效降低新生儿窒息的发生率,值得临床推广。Objective To explore the clinical outcome of bilateral pudendal nerve block combined with restrictive episiotomy in vaginal delivery.Methods A total of 240 primiparas,who underwent vaginal delivery with restrictive episiotomy from April to December 2018 in the Sixth People’s Hospital,were randomly divided into two groups(n=120):study group(bilateral pudendal nerve block anesthesia)and control group(unilateral pudendal nerve block anesthesia).Maternal perineum injury,visual analogue scale(VAS)score at the time of delivery and 2 hours after delivery,the time spent in the second stage of labor,the amount of postpartum hemorrhage,the incidence of postpartum urinary retention and the incidence of birth asphyxia were compared between the two groups.Results Maternal VAS scores in the study group were 2.2±0.8 at delivery and 1.9±0.4 at 2 hours after delivery,which were significantly lower than those in the control group(5.1±2.3 and 3.6±1.2,P<0.05).The incidence of perineal laceration was 60.0%(72/120)in the study group,which was significantly lower than that in the control group(87.5%,105/120,P<0.05).The second stage of labor in the study group was significantly shorter than that in the control group([45.6±14.7]min vs.[69.5±15.2]min,P<0.05).The postpartum hemorrhage in the study group was significantly less than that in the control group([134.3±26.4]mL vs.[183.5±25.7]mL,P<0.05).The incidences of postpartum urinary retention and neonatal asphyxia in the study group were 2.5%(3/120)and 1.7%(2/120),respectively,which were significantly lower than those in the control group(9.2%[11/120]and 8.3%[10/120],P<0.05).Conclusion Bilateral pudendal nerve block anesthesia combined with restrictive episiotomy deserves to be clinically promoted,as it can effectively reduce the incidence of pubertal perineal laceration,postpartum hemorrhage,and the incidence of neonatal asphyxia.

关 键 词：阴部神经阻滞麻醉 限制性会阴切开术 阴道分娩质量 

分 类 号：R713.2[医药卫生—妇产科学]