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| 硬膜外阻滞联合超声引导下阴部神经阻滞分娩镇痛的效果 |
| Effects of epidural block combined with ultrasound-guidedpudendal nerve block in labor analgesia |
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| DOI：10.12089/jca.2019.04.007 |
| 中文关键词: 分娩镇痛 硬膜外阻滞 阴部神经阻滞 超声 会阴损伤 |
| 英文关键词: Labor analgesia Epidural block Pudendal nerve block Ultrasound Perineal integrity |
| 基金项目:重庆市卫生和计划生育委员会面上项目（2017MSXM112） |
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| 中文摘要: |
目的 探讨硬膜外阻滞联合超声引导下阴部神经阻滞的分娩镇痛方案对产妇分娩疼痛、产程及保护会阴完整性的临床效果。
方法 选择2017年6—12月于本院要求行分娩镇痛的初产妇107例，年龄22～30岁，BMI 20～39.9 kg/m2，ASA Ⅱ级。随机分为硬膜外阻滞联合超声引导下阴部神经阻滞组（T组，n=54）和单纯硬膜外阻滞组（C组,n=53）。所有产妇在宫口扩张至3 cm时行硬膜外穿刺置管并连接镇痛泵。T组产妇在宫口开全时夹闭镇痛泵，并行超声引导下双侧阴部神经阻滞。C组产妇直至第三产程结束时停用镇痛泵。记录两组产妇宫口扩张至3 cm、硬膜外阻滞后30 min、胎头着冠时和会阴缝合时的VAS评分；记录第二产程时间，使用器械助产、会阴侧切情况和会阴撕裂程度；记录产妇分娩后24 h内局部血肿、局麻药中毒、蛛网膜穿破和大小便失禁等不良反应发生情况。
结果 与硬膜外阻滞后30 min比较，胎头着冠时T组VAS评分明显降低（P<0.05）、C组明显升高（P<0.05）。胎头着冠和会阴缝合时T组VAS评分明显低于C组（P<0.05）。T组第二产程时间明显短于C组（P<0.05），会阴侧切率明显低于C组（P<0.05），会阴撕裂程度明显轻于C组（P<0.05）。两组使用器械助产率差异无统计学意义。所有产妇均未发生局部血肿、局麻药中毒、蛛网膜穿破、大小便失禁等不良反应。
结论 硬膜外阻滞联合超声引导下阴部神经阻滞较单纯硬膜外阻滞能更有效地缓解分娩疼痛，缩短产程，减少会阴损伤，保护会阴完整性。 |
| 英文摘要: |
Objective To discuss the clinical effects of epidural block combined with ultrasound-guided pudendal nerve block on labor pain, stages of labor and perineal integrity protection.
Methods A total of 120 primiparae， aged 22-30 years, BMI 20-39.9 kg/m2, ASA physical status Ⅱ, who required labor analgesia from June to December, 2017 in our hospital were selected. These primiparae were randomly divided into epidural block combined with ultrasound-guided pudendal nerve block group (Group T) and only epidural block group (Group C), 60 cases in each group. All primiparae received epidural catheterization and connected with analgesia pump when cervical orifice was dilated to 3 cm. For primiparae in Group T, the pump was clipped and bilateral pudendal nerve block was performed under ultrasound when cervix completely opened. For Group C, the pump was not stopped until the end of the third labor stage. The VAS of the two groups were recorded at the time points of cervix reaching 3cm, 30 min after epidural block, fetus crowning and perineum being sutured. The duration of the second labor stage, any instrument-associated delivery, lateral episiotomy, perineum laceration, and any complications within 24 h after delivery (including but not limited to local hematoma, local anesthetic poisoning, arachnoid puncture and incontinence of urine and feces) were also recorded for both groups.
Results Compared with 30 min after epidural block, VAS was obviously lower in Group T during crowning (P<0.05), and higher in Group C (P<0.05). At the time of fetus crowning and perineum being sutured, VAS of group T was significantly lower than that of group C (P<0.05). Shorter duration of second labor stage was observed in group T than in group C(P<0.05). The rate of perineum episiotomy and the extent of perineum laceration were considerably lower in group T than in group C (P<0.05). There was no statistically significant difference in the rate of instrumental delivery between the two groups. No complications including but not limited to local hematoma, local anesthetic poisoning, arachnoid puncture and incontinence of urine and feces occurred in any primipara during the study period.
Conclusion Epidural block combined with ultrasound-guided pudendal nerve block is more effective than simple epidural block in terms of relieving labor pain, shortening labor stage duration, reducing perineum damage and protecting the integrity of perineum. |
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