双侧阴部神经阻滞麻醉对存在会阴裂伤诱因产妇分娩的影响

Influence of Block of Bilateral Pudendal Nerves on the Delivery of Lying-in Women Predisposed to Perineal Laceration

目的探讨双侧阴部神经阻滞麻醉用于存在诱发会阴裂伤因素 (会阴过紧、耻骨弓过低、胎儿过大 )产妇分娩的效果。方法将足月分娩中会阴过紧、耻骨弓过低、胎头过大的初产妇 316例随机分为两组 ,观察组 16 6例行双侧阴部神经阻滞麻醉后会阴侧斜切开娩出 ,对照组 15 0例行单侧阴部神经阻滞麻醉后会阴侧斜切开娩出。结果两组胎头拨露至胎儿娩出时间、第二产程时间、伤口缝合时间、产后 2h出血量及会阴裂伤发生率比较 ,观察组均显著少于对照组 (P <0 .0 5 ,P <0 .0 1)。结论双侧阴部神经阻滞麻醉能充分松弛会阴 ,缩短胎头拨露至胎儿娩出时间 ,缩短第二产程 ,降低会阴裂伤发生率。

Objective To examine the influence of block of bilateral pudendal nerves on the delivery of lying-in women predisposed to perineal laceration due to such factors as tight perineum, low pubic arch and big fetal head. Methods Three hundred and sixteen primiparae with such factors as tight perineum, low pubic arch, and big fetal head were divided into two groups: experimental group and control group. One hundred and sixty-six women in the experimental group were subjected to lateral episiotomy by using block of bilateral pudendal nerves while in 150 subjects in the control group, lateral episiotomy was performed with block of unilateral pudendal nerve. Results The time interval between head visible on vulval gapping and expulsion, the time of the second stage of labor, the time of wound suturing were significantly shorter, bleeding was less and incidence of perineal laceration was significantly lower than those in controls ( P <0.05 or P <0.01). Conclusion The block of bilateral pudendal nerves can fully relax peri- neum, shorten the time between head visible on vulval gapping and expulsion and the time of the second stage of labor, thereby reducing the possibility of perineal laceration.