目的探讨第二产程不同镇痛方法对初产妇分娩疼痛与会阴结局的影响。方法采用前瞻性随机对照研究。选取2023年8月1日至11月30日,在江南大学附属妇产医院产房,经阴道分娩且行硬膜外分娩镇痛的初产妇120例,足月单胎,年龄18~35岁。根据随机数字表法将其分为阴部神经阻滞组(A组)与硬膜外加药组(B组),每组60例。两组均实施程控式硬膜外分娩镇痛。在第二产程胎头拨露2~3 cm时,A组以坐骨棘为标志行单侧阴部神经阻滞和局部浸润麻醉(1%利多卡因20 ml);B组经硬膜外导管给予2%利多卡因5 ml。采用疼痛视觉模拟评分(VAS)评估两组产妇胎儿娩出时(T1)、会阴缝合时(T2)及产后2 h(T3)的疼痛情况,并记录产后出血、产后尿潴留发生情况,新生儿1 min Apgar评分及会阴结局。采用SPSS 26.0统计软件进行统计分析。结果B组产妇各时点VAS评分均低于A组(P均<0.05)。A组产妇第二产程时长长于B组[(50.2±29.8)min比(37.2±19.1)min,t=2.86,P=0.005]。两组产后出血率、产后尿潴留率及新生儿1 min Apgar评分差异均无统计学意义(P均>0.05)。两组产妇会阴结局差异有统计学意义(χ^(2)=7.13,P=0.028),B组产妇会阴切开率低于A组[26.7%(16/60例)比35.0%(21/60例)]。结论第二产程硬膜外追加局麻药物可减轻产妇分娩疼痛,降低会阴切开率,且未对母婴结局产生消极影响。
随着医疗技术的进步,我国全膝关节置换术数量不断增加,如何有效缓解术后疼痛已经成为临床医生所关注的重要难题。其中,外周神经阻滞是多模式镇痛的重要组成,其对TKA患者术后功能康复具有良好的促进作用,并且可以明显减少镇痛药物,常用阻滞方式包括股神经阻滞、坐骨神经阻滞、内收肌管阻滞等。本文对TKA围术期镇痛方法进行综述,并重点讨论以区域神经阻滞为主导的多模式镇痛方法。With the advancement of medical technology, the number of total knee arthroplasty surgeries in China continues to increase, and how to effectively alleviate postoperative pain has become an important issue of concern for clinical doctors. Among them, peripheral nerve block is an important component of multimodal analgesia, which has a good promoting effect on postoperative functional rehabilitation of TKA patients and can significantly reduce analgesic drugs. Common block methods include femoral nerve block, sciatic nerve block, adductor canal block, and local infiltration anesthesia around joints. This article provides a review of perioperative analgesia methods for TKA, with a focus on multimodal analgesia methods dominated by regional nerve block.
