无保护会阴接生联合会阴阻滞麻醉用于自然分娩的临床研究

CLINICAL RESEARCH ON THE EFFECT OF UNPROTECTED-PERINEUM DELIVERY AND PERINEAL BLOCK ANESTHESIA ON NATURAL DELIVERY

目的探讨无保护会阴接生联合会阴阻滞麻醉对产程和新生儿的影响。方法将200例足月头位正常分娩初产妇分为两组各100例,实验组在产妇宫口开全后,等胎头刚拨露时行双侧会阴阻滞麻醉,助产士指导产妇呼吸哈气,在无保护会阴状态下分娩;对照组采用传统保护会阴的接生方法进行接产。结果两组第一产程时间及产后出血量、新生儿窒息发生率无差异;实验组第二产程时间短于对照组(t=7.167,P=0.00),会阴侧切率低(χ2=12.21,P=0.00),会阴完整率高(χ2=9.89,P=0.00),Ⅰ度裂伤多于对照组(χ2=4.08,P=0.043);实验组会阴疼痛不适感明显少于对照组(χ2=22.86,P=0.000)。结论足月头位初产妇正常分娩中,无保护会阴接生联合会阴阻滞麻醉可降低会阴侧切率,减少会阴损伤,明显减轻会阴疼痛不适感,降低了新生儿窒息率,使分娩回归自然。

Objective To explore the effect of unprotected-perineum delivery and perineal block anesthesia on stage of labor and newborns.Methods 200 cases of full-term and normal-dead-position-fetus unipara delivery were evenly divided into two groups.The experimental group underwent cesarean section,bilateral perineal block anesthesia was given when fetal head began to emerge and unprotected-perineum delivery was conducted with the midwife＇s instruction on breathing.The contrast group received protected-perineum delivery.Results No significant dneonatal asphyxiaifferences were found in time,postnatal amount of bleeding and the rate of neonatal asphyxia at the first stage of labor.When compared with the contrast group at the second stage of labor,the experiment group used less time in labor（t=7.167,P =0.00）,showed lower rate of lateral episiotomy（χ^2=12.21,P =0.00）and higher intact rate of perineum（χ^2=9.89,P =0.00）and had more first-degree lacerations（χ^2=4.08,P =0.043）and less perineal discomfortableness（χ^2=22.86,P =0.000）.Conclusion The method of combined use of unprotected-perineum delivery and perineal block anesthesia can reduce the rate of lateral episiotomy and perineal injury,relieve perineal discomfortableness and reduce the rate of neonatal asphyxia.