初产妇第二产程应用盐酸利多卡因的效果观察

Effect of using the lidocaine in the second stage of labor among primiparas

目的探讨在第二产程的不同时机应用药物镇痛对产妇及胎儿的影响。方法将300例宫口开全的初产妇分为三组，每组100例。A组宫缩时有排便感且肛门褶松开时应用盐酸利多卡因行双侧阴部神经阻滞麻醉；B组在胎头拨露2—3cm时应用盐酸利多卡因行双侧阴部神经阻滞麻醉；C组不进行镇痛处理。结果第二产程时间A组最短、C组最长，且A、B两组与C组比较差异有统计学意义；与C组比较，A、B两组疼痛程度明显减轻，会阴完整率高，会阴侧切率低，会阴裂伤程度轻，差异均有统计学意义。结论在初产妇第二产程应用盐酸利多卡因行双侧阴部神经阻滞麻醉，能缩短第二产程，减轻分娩疼痛，降低会阴侧切率、会阴裂伤率，提高会阴完整率；同时，宫口开全立即用药较胎头拨露用药缩短第二产程的效果更好。

Objective To explore the influence of using lidocaine in the second stage of labor among primiparas. Methods 300 primiparas were divided into three groups. When Group A has uterus contractions with anal fold releasing, bilateral pudendal nerve was conducted by block anesthesia with lidocaine hydrochloride. When Group B has the uterus contractions with head visible on vulva gapping 2 - 3 cm, lidocaine hydrochloride bilateral pudendal nerve was carried out by block anesthesia. Group C was not carried out any measures. Results The shortest time of the second stage is Group A. Group C is the longest one. Pain in groups A, B significantly reduced than in group C. The condition of perineum in Group A and B were better than that of in Group C, the rate of postero-lateral episiotomy and the level of perineal laceration in Group C were higher. Conclusions Bilateral pudendal nerve block anesthesia can shorten the second stage of labor and suturing time, alleviate the pain of delivery, reduce the rate of postero-lateral episiotomy and the perineal laceration, and raise the rate of perineal integrity. Compared with the head visible on vulva gapping, dilatation of cervix 10 cm can get the better effect of shortening the second stage of labor.