目的 探讨腰-硬联合阻滞分娩镇痛方式对初产妇在产程进展及产时发热的影响,为临床实践提供理论依据。方法 回顾性分析2020年12月—2021年12月在广州市某三甲医院产科分娩产妇535例的基本资料。观察组（285例）采用腰-硬联合阻滞麻醉分娩镇痛,对照组（250例）选择常规无干预分娩。结果 观察组中的产妇第一产程和第二产程的时间比对照组更长,且产后2 h出血量高于对照组,差异有统计学意义（P<0.05）,除此之外,2组产妇产时发热率比较差异也有统计学意义（P<0.01）。结论 腰硬联合阻滞分娩镇痛在一定程度上会延长产程,且产后2 h的出血量较多,同时也会增加产时发热的概率,存在一定不良反应,故需要密切观察,保证母儿安全。

Objective To investigate the effect of combined spinal-epidural block anesthesia on the progress of labor and intrapartum fever in primipara,and to provide a theoretical basis for clinical practice．Methods The basic data of 535 pregnant women who gave birth in the obstetrics department of a tertiary hospital in Guangzhou from December 2020 to December 2021 were retrospectively analyzed．The observation group（285 cases）was given labor analgesia,and the control group（250 cases）was given routine non-intervention delivery．Results The time of the first stage of labor and the second stage of labor in the observation group was significantly longer than that in the control group,and the bleeding volume 2 hours after delivery was higher than that in the control group,and the difference was statistically significant（P<0.05）．The maternal fever rate during delivery also had statistical significance（P<0.01）．Conclusions Combined spinal-epidural block anesthesia will prolong the labor process to a certain extent,and the amount of bleeding in 2 hours after delivery will be more,and it will also increase the probability of intrapartum fever,with certain adverse reactions．Therefore,close observation is needed to ensure the mother and child safety．

目的 探讨双侧会阴神经阻滞麻醉配合综合护理在降低单胎初产妇顺产会阴侧切率中的应用效果。方法 选取2019年7月—2019年12月在我院经阴道分娩的顺产初产妇110例为研究对象,按照随机数字表法分成两组,每组各55例,所选产妇对照组产妇给予常规护理模式,给予局部浸润麻,观察组产妇在对照组基础上采用综合护理模式,给予双侧会阴神经阻滞麻醉,比较两组产妇会阴侧切情况、会阴裂伤情况、产程持续时间、VAS评分、新生儿Apgar评分、依从性情况及护理效果等相关指标。结果 和对照组相比,观察组患者会阴侧切发生率少于对照组(P＜0.05),第一、第二产程时间短于对照组(P＜0.05);同对照组相比,观察组产妇在VAS评分、依从性及满意度指标均优于对照组(P＜0.05),而新生儿窒息、产后出血发生情况比较差异无统计学意义(P＞0.05)。结论 双侧会阴神经阻滞麻醉配合综合护理可以有效降低初产妇会阴侧切的发生率,减轻分娩时的疼痛,缩短产程,提高产妇依从性及满意度,具有较高的临床推广价值。

Objective To explore the effect of bilateral perineum nerve block anesthesia combined with comprehensive nursing in reducing the rate of perineum side cutting of primipara. Methods 110 primiparas who delivered vaginally in our hospital from July 2019 to December 2019 were selected as the research objects. According to the random number table method, they were divided into two groups, 55 in each group. The control group was given the routine nursing mode and local infiltration anesthesia. The observation group was given the comprehensive nursing mode and bilateral perineum nerve block anesthesia on the basis of the control group. The perineum side cutting status, perineum laceration, duration of labor, VAS score, Apgar score, compliance and nursing effect of the two groups were compared. Results Compared with the control group, the incidence of perineum side cutting was lower in the observation group than that in the control group (P<0.05).The first and second stages of labor were shorter in the observation group than the control group (P<0.05); compared with the control group, the VAS score, compliance and satisfaction index were better in the observation group than the control group (P<0.05), but there was no significant difference in neonatal asphyxia and postpartum hemorrhage (P>0.05). Conclusion Bilateral perineum nerve block anesthesia combined with comprehensive nursing may effectively reduce the incidence of perineum lateral incision of primipara, reduce the pain during delivery, shorten the labor process, improve the compliance and satisfaction of parturients, and has a high clinical value.