第二产程不同镇痛方法对初产妇分娩疼痛与会阴结局的影响  

Effects of different analgesia methods at the second stage of labor on pain and perineal outcomes in primiparas

作　　者：朱丹 叶超 李晓 周波 施勤 张邓新 Zhu Dan;Ye Chao;Li Xiao;Zhou Bo;Shi Qin;Zhang Dengxin(Department of Delivery Room,Obstetrics and Gynecology Hospital of Jiangnan University,Wuxi City,Jiangsu Province 214002,China;Jiangnan University Wuxi Medical College,Wuxi City,Jiangsu Province 214122,China;Department of Anesthesiology,Obstetrics and Gynecology Hospital of Jiangnan University,Wuxi City,Jiangsu Province 214002,China)

机构地区：[1]江南大学附属妇产医院产房,江苏省无锡市214002 [2]江南大学无锡医学院,江苏省无锡市214122 [3]江南大学附属妇产医院麻醉科,江苏省无锡市214002

出　　处：《中华疼痛学杂志》2024年第4期560-564,共5页Chinese Journal Of Painology

基　　金：江苏省妇幼保健协会科研项目(FYX202302);江苏省无锡市妇幼健康适宜技术推广项目(FYTG202201);无锡市科学技术协会软课题项目(KX-24-A13)。

摘　　要：目的探讨第二产程不同镇痛方法对初产妇分娩疼痛与会阴结局的影响。方法采用前瞻性随机对照研究。选取2023年8月1日至11月30日,在江南大学附属妇产医院产房,经阴道分娩且行硬膜外分娩镇痛的初产妇120例,足月单胎,年龄18~35岁。根据随机数字表法将其分为阴部神经阻滞组(A组)与硬膜外加药组(B组),每组60例。两组均实施程控式硬膜外分娩镇痛。在第二产程胎头拨露2~3 cm时,A组以坐骨棘为标志行单侧阴部神经阻滞和局部浸润麻醉(1%利多卡因20 ml);B组经硬膜外导管给予2%利多卡因5 ml。采用疼痛视觉模拟评分(VAS)评估两组产妇胎儿娩出时(T1)、会阴缝合时(T2)及产后2 h(T3)的疼痛情况,并记录产后出血、产后尿潴留发生情况,新生儿1 min Apgar评分及会阴结局。采用SPSS 26.0统计软件进行统计分析。结果B组产妇各时点VAS评分均低于A组(P均<0.05)。A组产妇第二产程时长长于B组[(50.2±29.8)min比(37.2±19.1)min,t=2.86,P=0.005]。两组产后出血率、产后尿潴留率及新生儿1 min Apgar评分差异均无统计学意义(P均>0.05)。两组产妇会阴结局差异有统计学意义(χ^(2)=7.13,P=0.028),B组产妇会阴切开率低于A组[26.7%(16/60例)比35.0%(21/60例)]。结论第二产程硬膜外追加局麻药物可减轻产妇分娩疼痛,降低会阴切开率,且未对母婴结局产生消极影响。Objective To explore the effects of different analgesia methods at the second stage of labor on pain and perineal outcomes in primiparas.Methods A prospective randomized controlled study was conducted.A total of 120 primiparas,full-term pregnancy,aged 18-35 years old,undergoing vaginal delivery with epidural labor analgesia in the Department of Delivery Room,Obstetrics and Gynecology Hospital of Jiangnan University from August 1 to November 30,2023,were selected,and were randomly divided into the pudendal nerve block group(group A)and the epidural block group(group B)according to the random number table method,with 60 cases in each group.Both groups underwent programmed epidural labor analgesia.In the second stage of labor,the primiparas received unilateral pudendal nerve block and local infiltration anesthesia(20 ml of 1%lidocaine)at one side in group A,and administered 5 ml of 2%lidocaine through the epidural catheter in group B.The visual analogue scale(VAS)was assessed at the time of fetal delivery(T1),perineal suturing(T2),and 2 hours postpartum(T3).The incidence of postpartum hemorrhage,postpartum urinary retention,1-minute Apgar score of the newborn,and perineal outcome were recorded.SPSS 26.0 software was used for statistic analysis.Results VAS were lower in group B than those in group A at each time point(all P<0.05).The duration of the second stage of labor was shorter in group A than that in group B[(50.2±29.8)min vs.(37.2±19.1)min,t=2.86,P=0.005].The rates of postpartum hemorrhage and postpartum urinary retention,and 1-minute Apgar score of the newborn had no statistically significant differences between the two groups(all P>0.05),but the perineal outcome had a significantly statistical difference between the two groups(χ^(2)=7.13,P=0.028),with a lower rate of episiotomy in group B[26.7%(16/60 cases)vs.35.0%(21/60 cases)].Conclusion The additional epidural analgesia in the second stage of labor can alleviate the pain during the delivery process and reduce the rate of episiotomy,without a negative i

关 键 词：产程 第二 镇痛 分娩疼痛 会阴损伤 初产妇 

分 类 号：R714.3[医药卫生—妇产科学]