两种麻醉方式联合使用对会阴部撕裂程度及宫缩疼痛程度的影响
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摘要
目的:观察采取利多卡因会阴局部浸润麻醉联合双侧会阴部神经阻滞麻醉对产妇会阴部的撕裂程度及宫缩疼痛程度的影响分析。方法:选取衡水市第二人民医院产科2018年1月至2018年8月接收的单胎、头位产妇334例,随机数字法分成对照组和联合组(对照组和观察组)两组,每组各167例产妇。对照组在第二产程仅给予利多卡因局部浸润麻醉,而联合(观察组)组在第二产程采取利多卡因会阴局部浸润麻醉联合双侧会阴部神经阻滞麻醉。将两组产妇产后会阴状况(包括会阴完整、会阴侧切、会阴裂伤率)、第二产程时长与疼痛VAS评分、新生儿出生1min和5min后的Apgar评分进行对照。结果:联合组(观察组)产妇产后会阴完整率高于对照组,且侧切率、裂伤率及程度均低于对照组,差异具有统计学意义(P <0. 05)。联合组(观察组)第二产程时间与疼痛VAS评分明显少于对照组,且各项不良妊娠结局比例均少于对照组,差异具有统计学意义(P <0. 001)。联合组新生儿出生后1min和5min后的Apgar评分高于对照组,差异具有统计学意义(P <0. 01)。结论:对于自然分娩产妇而言,采取利多卡因局部浸润麻醉联合双侧会阴部神经阻滞麻醉,可明显降低会阴侧切、会阴部撕裂的几率,提高生产后会阴的完整率,缩短第二产程时长,降低产妇宫缩疼痛程度,提高新生儿的健康,效果理想。
Objective:To observe the effect of lidocaine perineal local infiltration anesthesia combined with bilateral perineal nerve block anesthesia on the degree of perineal tear and contraction pain. Methods: A total of334 women with singleton pregnancy and cephalic presentation in the Second People' s Hospital of Hengshui City from January 2018 to August 2018 were randomly divided into the control group and the combined group( observation group),167 women in the group. The control group received only lidocaine perineal local infiltration anesthesia in the second stage of labor,while the combined group( observation group) received lidocaine perineal local infiltration anesthesia combined with bilateral perineal nerve block anesthesia in the second stage of labor. The postpartum perineal status( including perineal integrity,side-cutting,perineal laceration),duration of the second stage of labor and pain VAS score,Apgar score at 1 min and 5 min after neonatal birth were compared in the two groups. Results:The postpartum perineal integrity rate was higher in the combined group( observation group) than that in the control group,and the incidence and degree of side-cutting and laceration were lower than that in the control group,with statistically significant differences( P < 0. 05). The duration of second stage of labor and pain VAS scores in the combined group( observation group) were significantly lower than those in the control group,and the proportion of adverse pregnancy outcomes was lower than that in the control group,with statistically significant differences( P <0. 001). The Apgar scores of the combined group were higher than those of the control group at 1 min and 5 min after birth,with statistically significant differences( P < 0. 01). Conclusions: For women to adopt natural delivery,the joint use of lidocaine perineal local infiltration anesthesia and bilateral perineal nerve block anesthesia can significantly reduce the incidence of perineal side-cutting and perineal tear,improve the rate of perineal integrity after delivery,shorten the duration of the second stage of labor,reduce the pain of maternal contractions,and improve thehealth of newborns.
Objective:To observe the effect of lidocaine perineal local infiltration anesthesia combined with bilateral perineal nerve block anesthesia on the degree of perineal tear and contraction pain. Methods: A total of334 women with singleton pregnancy and cephalic presentation in the Second People' s Hospital of Hengshui City from January 2018 to August 2018 were randomly divided into the control group and the combined group( observation group),167 women in the group. The control group received only lidocaine perineal local infiltration anesthesia in the second stage of labor,while the combined group( observation group) received lidocaine perineal local infiltration anesthesia combined with bilateral perineal nerve block anesthesia in the second stage of labor. The postpartum perineal status( including perineal integrity,side-cutting,perineal laceration),duration of the second stage of labor and pain VAS score,Apgar score at 1 min and 5 min after neonatal birth were compared in the two groups. Results:The postpartum perineal integrity rate was higher in the combined group( observation group) than that in the control group,and the incidence and degree of side-cutting and laceration were lower than that in the control group,with statistically significant differences( P < 0. 05). The duration of second stage of labor and pain VAS scores in the combined group( observation group) were significantly lower than those in the control group,and the proportion of adverse pregnancy outcomes was lower than that in the control group,with statistically significant differences( P <0. 001). The Apgar scores of the combined group were higher than those of the control group at 1 min and 5 min after birth,with statistically significant differences( P < 0. 01). Conclusions: For women to adopt natural delivery,the joint use of lidocaine perineal local infiltration anesthesia and bilateral perineal nerve block anesthesia can significantly reduce the incidence of perineal side-cutting and perineal tear,improve the rate of perineal integrity after delivery,shorten the duration of the second stage of labor,reduce the pain of maternal contractions,and improve thehealth of newborns.
引文
[1]王育芬,叶云玲,王茜.不同助产方式配合无保护会阴接生的临床分析.中国计划生育和妇产科,2015,7(3):24-26,47.
[2]零恒莉,潘敏,王巧霜.控制胎头娩出及无保护会阴接生的临床效果分析.广西医学,2014,36(3):398-399,封三.
[3]Huang J,Gu Y.Unprotected perineal birth method in improving the natural birth rate of primipara and the role of promoting the production process.Chinese maternal and child health care,2016,31(22):4639-4641.
[4]Gao J,fan L.Application of unprotected perineum graft method in vaginal delivery.southeast defense medicine,2014,16(6):639-640.
[5]王芳,周丹,邢梅.无保护会阴接生技术与控制胎头娩出方案对母婴结局的影响.检验医学与临床,2016,13(10):1418-1420.
[6]蒋敏.控制胎头娩出及无保护会阴接生的临床效果分析.临床和实验医学杂志,2015,14(19):1646-1647.
[7]郑后,顾凯芬,余佩红.阴部管内神经阻滞麻醉配合无保护会阴接生的效果观察.浙江医学教育,2017,16(2):44-47.
[8]张萍,黄萍.双侧阴部神经阻滞麻醉配合无保护会阴接生法在初产妇自然分娩中的应用效果评价.当代医药论丛,2017,15(8):29-30.
[9]郑萍.双侧阴部神经阻滞麻醉在无保护接生技术中的应用效果观察.青海医药杂志,2016,46(8):12-14.
[10]韩杰.双侧阴部神经阻滞麻醉会阴无保护或适度保护在阴道分娩中的应用.青海医药杂志,2016,46(8):23-24.
[11]朱骏,刘兰萍,嵇曹,等.双侧阴部和会阴神经阻滞麻醉联合无保护助产在自然分娩中临床应用.中国医院用药评价与分析,2016,16(S1):160-162.
[12]闫成美,郜素敏,李挺芳.双侧阴部神经阻滞麻醉在自然分娩中的应用.解放军护理杂志,2005,22(1):18-19.
[13]胡林华,梁玲霞,吴天霞.双侧阴部神经阻滞麻醉在自然分娩中的应用.齐鲁护理杂志,2006,12(3b):516-517.
[14]张文秀.双侧阴部神经阻滞麻醉在自然分娩中临床应用.中国保健营养旬刊,2013,33(5):2369-2370.
[15]董惠兰.双侧阴部神经阻滞麻醉在阴道分娩中保持会阴完整的临床应用.医学理论与实践,2013,26(9):1199-1200.
[16]杨生兰,吴梅秀,张慧萍.双侧阴部神经阻滞麻醉改良法在临床分娩中的应用.齐鲁护理杂志,2014,20(18):9-11.
[17]张春红,张艳红.双侧阴部神经阻滞麻醉在阴道分娩中的应用.当代护士旬刊,2013(10):61-62.
[18]Jansova M,Kalis V,Rusavy Z,et al.Modeling manual peri-neal protection during vaginal delivery.International Ur-ogynecology Journal,2014,25(1):65-71.
[19]Petrocnik P,Marshall JE.Hands-poised technique:The fu-ture technique for perineal management of second stage of labour a modified systematic literature review.Midwife-ry,2015,31(2):274-279.
[20]杨生兰,吴梅秀,张慧萍.双侧阴部神经阻滞麻醉改良法在临床分娩中的应用.齐鲁护理杂志,2014,20(18):9-11.
[2]零恒莉,潘敏,王巧霜.控制胎头娩出及无保护会阴接生的临床效果分析.广西医学,2014,36(3):398-399,封三.
[3]Huang J,Gu Y.Unprotected perineal birth method in improving the natural birth rate of primipara and the role of promoting the production process.Chinese maternal and child health care,2016,31(22):4639-4641.
[4]Gao J,fan L.Application of unprotected perineum graft method in vaginal delivery.southeast defense medicine,2014,16(6):639-640.
[5]王芳,周丹,邢梅.无保护会阴接生技术与控制胎头娩出方案对母婴结局的影响.检验医学与临床,2016,13(10):1418-1420.
[6]蒋敏.控制胎头娩出及无保护会阴接生的临床效果分析.临床和实验医学杂志,2015,14(19):1646-1647.
[7]郑后,顾凯芬,余佩红.阴部管内神经阻滞麻醉配合无保护会阴接生的效果观察.浙江医学教育,2017,16(2):44-47.
[8]张萍,黄萍.双侧阴部神经阻滞麻醉配合无保护会阴接生法在初产妇自然分娩中的应用效果评价.当代医药论丛,2017,15(8):29-30.
[9]郑萍.双侧阴部神经阻滞麻醉在无保护接生技术中的应用效果观察.青海医药杂志,2016,46(8):12-14.
[10]韩杰.双侧阴部神经阻滞麻醉会阴无保护或适度保护在阴道分娩中的应用.青海医药杂志,2016,46(8):23-24.
[11]朱骏,刘兰萍,嵇曹,等.双侧阴部和会阴神经阻滞麻醉联合无保护助产在自然分娩中临床应用.中国医院用药评价与分析,2016,16(S1):160-162.
[12]闫成美,郜素敏,李挺芳.双侧阴部神经阻滞麻醉在自然分娩中的应用.解放军护理杂志,2005,22(1):18-19.
[13]胡林华,梁玲霞,吴天霞.双侧阴部神经阻滞麻醉在自然分娩中的应用.齐鲁护理杂志,2006,12(3b):516-517.
[14]张文秀.双侧阴部神经阻滞麻醉在自然分娩中临床应用.中国保健营养旬刊,2013,33(5):2369-2370.
[15]董惠兰.双侧阴部神经阻滞麻醉在阴道分娩中保持会阴完整的临床应用.医学理论与实践,2013,26(9):1199-1200.
[16]杨生兰,吴梅秀,张慧萍.双侧阴部神经阻滞麻醉改良法在临床分娩中的应用.齐鲁护理杂志,2014,20(18):9-11.
[17]张春红,张艳红.双侧阴部神经阻滞麻醉在阴道分娩中的应用.当代护士旬刊,2013(10):61-62.
[18]Jansova M,Kalis V,Rusavy Z,et al.Modeling manual peri-neal protection during vaginal delivery.International Ur-ogynecology Journal,2014,25(1):65-71.
[19]Petrocnik P,Marshall JE.Hands-poised technique:The fu-ture technique for perineal management of second stage of labour a modified systematic literature review.Midwife-ry,2015,31(2):274-279.
[20]杨生兰,吴梅秀,张慧萍.双侧阴部神经阻滞麻醉改良法在临床分娩中的应用.齐鲁护理杂志,2014,20(18):9-11.