第二产程阴部神经阻滞麻醉时机的研究

Research in the pudendal nerve block anesthesia timing during second stage of labor

目的探讨第二产程中，先露在不同位置时施行阴部神经阻滞麻醉，对产妇疼痛程度及产程的影响，从而选择适当的麻醉时机，最大程度减轻疼痛，缩短产程，增加产妇的舒适感，为产妇提供最佳服务。方法选取足月单胎可以阴道分娩初产妇200例，随机编号，奇数组为观察组，偶数组为对照组，每组各100例。观察组在第二产程，先露下降至坐骨棘下1cmS＋I后，即用1％利多卡因行双侧阴部神经阻滞麻醉；对照组在胎头拨露后，会阴切开前才施行切开侧阴部神经阻滞麻醉。结果2组产妇在疼痛程度、第二产程时间、会阴损伤程度方面比较，差异有统计学意义。观察组Ⅱ级、Ⅲ级疼痛者比对照组少32例；观察组会阴切开后延裂例数比对照组少24例；观察组第二产程在1h内分娩例数比对照组多2l例。结论在第二产程，先露下降至S＋1后，实施双侧阴部神经阻滞麻醉，可使阴部盆底组织松弛，减轻分娩时疼痛，缩短第二产程，减少会阴损伤程度。

Objective To discuss the influence of pudendal nerve block anesthesia on pain degree and labor course when presentation at different positions during the second stage of labor, in order to find the better anesthesia timing and method to reduce pain, shorten labor, increase maternal comfort to a maxi- mum extent and provide the best service for the maternal. Methods 200 cases of primiparas with full- term and single-birth were selected and numbered randomly, patients with odd numbers were set to the ob- servation group, patients with even numbers were set to the control group, 100 cases in each group. In the observation group, when the presentation reached S＋I, 1% lidocaine was used to perform pudendal nerve block anesthesia. In the control group, the pudendal nerve block anesthesia was performed before perineal incision. Results The pain intensity, time of the second labor stage, perineum damage degree between the two groups were statistically different. The observation group with I1 -grade level, III- grade level pain were 32 cases less than that of the control group. The perineum incision later crack number in the observation group was 24 cases less than that of the control group. The number of delivery within 1 hour in the second la- bor process in the observation group was 21 cases more than that in the control group. Conclusions Im- plementation of bilateral pudendal nerve block anesthesia in the second stage of labor when the presentation reaches S＋I can alleviate childbirth pain, shorten the second stage of labor, reduce the degree of perineal trauma.