持续硬膜外麻醉联合无保护会阴接生对分娩疼痛和产程的影响

The effect of epidural anesthesia combined with unprotected perineum delivery on labor pain and process

目的探讨硬膜外麻醉联合无保护会阴接生对分娩疼痛和产程的影响,以缩短产妇的产程,减轻会阴损伤,提高自然分娩率。方法选取我院2016年4月至2017年12月待产妇160例,根据辅助分娩措施不同分为试验组和对照组各80例,试验组给予1μg/ml芬太尼和罗哌卡因6~8 ml诱导实施硬膜外麻醉,并给予无保护会阴助产接生技术;对照组给予常规助产分娩技术。疼痛判定标准采用视觉模拟评分法(VAS)评估产妇分娩疼痛程度,计算第一产程、第二产程、第三产程及总产程的时间,同时采用Bromage评分评估运动神经阻滞程度。结果试验组麻醉镇痛后不同产程时段VAS评分均明显下降,疼痛分级3级疼痛率为20.00%,明显低于对照组(P<0.05);两组第三产程比较差异无统计学意义(P>0.05),但第一产程、第二产程时间和总产程时间低于对照组(P<0.05)。两组麻醉Bromage评分差异无统计学意义(P>0.05),对运动神经阻滞作用均轻微,试验组3例出现皮肤瘙痒、2例出现尿潴留,4恶心呕吐,1例出现低血压和1例会阴水肿,总发生率为13.75%,与对照组比较差异无统计学差异(P>0.05)。试验组会阴裂伤发生率明显低于对照组(P<0.05)。结论硬膜外麻醉联合无保护会阴接生可发挥重要的镇痛作用,不延长产程时间且不增加对母体的不良反应,技术安全可靠。

Objective To investigate the effect of epidural anesthesia combined with unprotected deliveries on labor pain and process in order to shorten the maternal labor,lighten the perineal injury and improve the natural births. Methods One hundred and sixty cases were randomly selected from our hospital between April 2016 and December 2017.They were divided into experimental and control groups according to different auxiliary childbirth measures,80 in each group.The experimental group was given 1（ g/ml sufentanil and pp paid 6-8 ml to induce the epidural anesthesia,and received unprotected perineum midwife technology.The control group was given routine obstetric delivery technology.The pain was assessed by using visual analogue scale（ VAS）. The time at the first,second and third stages of labor as well as the total labor time were calculated.At the same time,the degree of motor nerve block was assessed with Bromage score evaluation.Results After anesthesia analgesia,VAS scores at different labor stages in the experimental group were obviously decreased and the rate of the third pain grading was 20. 00% that was significantly lower than that in the control group（ P〈0. 05）.There was no statistically significant difference in labor time between the two groups at the third labor stage（ P〈0. 05）.However,the time at the first and second labor stages and the total labor time in the experimental group were shorter than those in the control group（ P〈0. 05）. There was no significant difference in anesthesia Bromage score between the two groups（ P〈0. 05）. The motor nerve block effects were mild.In the experimental group,there were 3 cases with itchy skin,2 cases with urinary retention,4 cases with nausea and vomiting and 1 case with hypotension and perineum edema.The total incidence was 13. 75% that was not significantly different from the control group（ P〈0. 05）.The incidence of perineal laceration in the experimental group was significantly lower than that in the control group（ P〈0. 05）.Conclusion Epidural anesthesia combines with unprotected perineum deliveries has significant analgesic action,does not to extend the time of labor and increase the maternal adverse reactions.It is a safe and reliable technology.