摘要
产痛是正常阴道分娩不可避免的一部分,也是所有准备阴道分娩产妇最担心的问题。剧烈的产痛会给母婴造成很多的不利影响,比如呼吸性碱中毒、子宫收缩乏力、产程停滞、难产、新生儿窒息等,其中对初产妇的影响更为明显。近年来临床大力推广分娩镇痛技术,其中最为重要的是硬膜外阻滞分娩镇痛。硬膜外阻滞分娩镇痛可以通过减轻产痛,降低剖宫产率,还可以减轻会阴损伤,降低会阴侧切率及阴道助产率。同时硬膜外阻滞分娩镇痛不增加胎心率异常的概率、能减少产后出血量,且不良反应及近远期并发症较少。硬膜外阻滞分娩镇痛实施最初30 min,可能影响子宫收缩力,但通过人工缩宫素的干预可以迅速扭转,且不影响总产程进展。掌握合适的硬膜外阻滞时机,可以在有效镇痛的基础上缩短产程,但如果第一产程潜伏期宫口扩张<3 cm实施硬膜外阻滞镇痛,可能会延长初产妇第一产程,但是不增加母婴风险及并发症。本文对硬膜外阻滞在分娩镇痛中的应用进展进行综述,以期为减轻产妇分娩疼痛和促进顺利分娩提供参考方案。
Labor pain is an inevitable part of normal vaginal delivery,and it is also the most worrying problem of all delivery women preparing for vaginal delivery.Severe labor pain will cause many adverse effects on mothers and infants,such as respiratory alkalosis,uterine atony,labor stagnation,dystocia,neonatal asphyxia,etc.,among which the impact on delivery women is more obvious.In recent years,labor analgesia technology has been vigorously promoted in clinic,among which epidural block labor analgesia is the most important one.Epidural block labor analgesia can reduce labor pain,reduce the rate of cesarean section,reduce perineal injury,reduce the rate of lateral episiotomy and vaginal midwifery.At the same time,epidural block labor analgesia does not increase the probability of abnormal fetal heart rate,can reduce the amount of postpartum hemorrhage,and has less adverse reactions and short-term and long-term complications.The first 30 minutes of epidural block labor analgesia may affect the uterine contractility,but it can be reversed rapidly through the intervention of artificial oxytocin without affecting the progress of the total labor process.Mastering the appropriate timing of epidural block can shorten the labor process on the basis of effective analgesia.However,if the uterine dilation in the latent period of the first labor process is less than 3 cm,the implementation of epidural block analgesia may prolong the first labor process of primipara,but does not increase the risk of mother and infant and complications.This paper reviews the application progress of epidural block in labor analgesia,in order to provide a reference scheme for reducing maternal labor pain and promoting smooth delivery.
作者
李伟
翟丽
李万波
梁海燕
高莉军
LI Wei;ZHAI Li;LI Wan-bo;LIANG Hai-yan;GAO Li-jun(Department of Obstetrics and Gynecology,Tianjin Wuqing District People's Hospital,Tianjin 301700,China)
出处
《中国城乡企业卫生》
2022年第7期37-39,共3页
Chinese Journal of Urban and Rural Enterprise Hygiene
关键词
硬膜外阻滞
分娩镇痛
并发症
母婴结局
Epidural block
Labor analgesia
Complication
Maternal and infant outcome
