椎管内镇痛、阴部神经阻滞联合改良式会阴保护法在助产中的应用  

Combined application of intraspinal analgesia,bilateral pudendal nerve block anesthesia and modified perineal protection in midwifery

作　　者：张姣姣 李勤梅 管红云 Zhang Jiaojiao;Li Qinmei;Guan Hongyun(Department of Obstetrics and Gynaecology,Suqian Hospital of Nanjing Drum Tower Hospital Group(Suqian Hospital Affiliated to Xuzhou Medical University),Suqian 223800,Jiangsu Province,China)

机构地区：[1]南京鼓楼医院集团宿迁医院徐州医科大学附属宿迁医院妇产科,宿迁223800

出　　处：《中国基层医药》2022年第5期717-721,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨在临床助产中实施椎管内分娩镇痛、双侧阴部神经阻滞联合改良式会阴保护法的临床效果。方法选取南京鼓楼医院集团宿迁医院2019年1月至2021年1月收治的足月阴道分娩的初产妇160例为研究对象,采用随机数字表法分为对照组和观察组各80例。对照组采用双侧阴部神经阻滞联合改良式会阴保护法,观察组在对照组的基础上,联合椎管内分娩镇痛,分析比较各项临床指标。结果观察组产程时间[(7.23±2.11)h]短于对照组[(9.35±3.79)h](t=4.27,P<0.05),剖宫产率[8.7%(7/80)]低于对照组[52.5%(42/80)](χ^(2)=17.18,P<0.05)。会阴撕裂伤发生率[8.7%(7/80)]低于对照组[32.5%(26/80)](χ^(2)=15.48,P<0.05),两组均无Ⅲ度会阴撕裂伤。观察组产后下床活动时间[(1.37±0.13)d]及住院时间[(3.22±0.31)d]均短于对照组[(2.52±0.22)d、(5.23±0.62)d](t=25.90、25.94,均P<0.05)。观察组并发症发生率[7.5%(6/80)]低于对照组[23.7%(19/80)](χ^(2)=8.01,P<0.05)。两组新生儿窒息率、产后2 h出血量、产后出血等发生率比较,差异均无统计学意义(均P>0.05)。结论在足月阴道分娩的助产中,实施椎管内分娩镇痛、双侧阴部神经阻滞联合改良式会阴保护法,可缩短产程,降低剖宫产率。Objective To investigate the clinical efficacy of intraspinal analgesia,pudendal nerve block anesthesia and modified perineal protection in combination in midwifery.Methods A total of 160 primiparous women who were subjected to full-term vaginal delivery in Suqian Hospital of Nanjing Drum Tower Hospital Group between January 2019 and January 2021 were included in this study.They were randomly assigned to undergo either bilateral pudendal nerve block combined with modified perineal protection(control group,n=80)or intraspinal analgesia,pudendal nerve block anesthesia and modified perineal protection in combination(observation group,n=80).Each clinical index was compared between the control and observation groups.Results Duration of labor in the observation group was significantly shorter than that in the control group[(7.23±2.11)hours vs.(9.35±3.79)hours,t=4.27,P<0.05).Cesarean section rate in the observation group was significantly lower than that in the control group[8.7%(7/80)vs.52.5%(42/80),χ^(2)=17.18,P<0.05].Incidence of perineal tears in the observation group was significantly lower than that in the control group[8.7%(7/80)vs.32.5%(26/80),χ^(2)=15.48,P<0.05].Third-degree perineal tears occurred in neither group.Time of postpartum off-bed ambulation and length of postpartum hospital stay in the observation group were(1.37±0.13)days and(3.22±0.31)days,respectively,which were significantly shorter than those in the control group[(2.52±0.22)days,(5.23±0.62)days,t=25.90,25.94,both P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group[7.5%(6/80)vs.23.7%(19/80),χ^(2)=8.01,P<0.05].There were no significant differences in incidence of neonatal asphayxia,2-hour postpartum hemorrhage and postpartum hemorrhage between the two groups(all P>0.05).Conclusion During midwifery of full-term vaginal delivery,combined application of intraspinal analgesia,bilateral pudendal nerve block anesthesia and modified perineal protection can shorten duration of la

关 键 词：疼痛 产科 神经传导阻滞 麻醉 脊尾 自然分娩 剖宫产术 分娩并发症 妊娠结局 药物协同作用 

分 类 号：R717[医药卫生—妇产科学]