超声引导下双侧阴部神经阻滞联合硬膜外阻滞对顺产产妇会阴保护及妊娠结局的影响

Effect of ultrasound-guided bilateral pudendal nerve block combined with epidural block on perineal protection and pregnancy outcome of spontaneous delivery parturient

目的探讨超声引导下双侧阴部神经阻滞联合硬膜外阻滞对顺产产妇会阴保护及妊娠结局的影响。方法选取2019年1月—2020年6月安徽省第二人民医院住院分娩的80例顺产产妇为研究对象。按照随机数字表法将其分为对照组和研究组,每组40例。对照组予以硬膜外阻滞,研究组予以超声引导下双侧阴部神经阻滞联合硬膜外阻滞。比较两组会阴情况,不同时间点[宫口全开(T1)、胎头拨露(T2)、会阴缝合(T3)]视觉模拟评分(VAS),并观察两组产妇的妊娠结局。结果研究组产妇会阴完整率高于对照组,会阴侧切率低于对照组,差异均有统计学意义(均P<0.05)。两组产妇会阴裂伤程度比较,差异有统计学意义(P<0.05)。两组产妇T2、T3时VAS低于T1,差异均有统计学意义(均P<0.05);研究组产妇T2、T3时VAS低于对照组,差异均有统计学意义(均P<0.05)。研究组产妇的第二产程时间短于对照组;新生儿Apgar评分高于对照组,差异均有统计学意义(均P<0.05)。研究组新生儿窒息率和产后出血率低于对照组,差异均有统计学意义(均P<0.05)。结论超声引导下双侧阴部神经阻滞联合硬膜外阻滞对产妇会阴保护的作用显著,明显缩短产妇的产程时间,有效减少不良妊娠结局。

Objective To explore the effect of ultrasound-guided bilateral pudendal nerve block combined with epidural block on perineal protection and pregnancy outcome of spontaneous delivery parturient.Methods From January 2019 to June 2020,80 cases spontaneous delivery parturient who were hospitalized in the Second People’s Hospital of Anhui Province for delivery were selected as study subjects.According to the random number table method,they were divided into control group and study group,with 40 cases in each group.The control group were received epidural block,and the study group were received ultrasound-guided bilateral pudendal nerve block combined with epidural block.The perineal conditions and visual analogue score(VAS)at different time points(full hysterectomy[T1],fetal head exposure[T2],perineal suture[T3])of two groups were compared,and the pregnancy outcomes of two groups were observed.Results The perineal integrity rate of study group was higher than that of control group,and the perineal lateral resection rate was lower than that of the control group,and the differences were statistically significant(all P<0.05).There was statistical significance in the degree of perineal laceration between two groups(P<0.05).VAS at T2 and T3 in the two groups were lower than those at T1,and the differences were statistically significant(all P<0.05).VAS at T2 and T3 in study group were lower than those in control group,and the differences were statistically significant(all P<0.05).The time of the second stage of labor in study group was shorter than that in control group;Apgar score of neonates was higher than that of control group,and the differences were statistically significant(all P<0.05).The neonatal asphyxia rate and postpartum hemorrhage rate in study group were lower than those in control group,and the differences were statistically significant(all P<0.05).Conclusion Ultrasound-guided bilateral pudendal nerve block combined with epidural block has significant effect on perineal protection of parturient,significantly shorten the labor process time of parturient and effectively reduce adverse pregnancy outcomes.