两种局部麻醉方法在会阴侧切缝合中镇痛效果比 较

目的 观察两种会阴局部麻醉方法对会阴侧切缝合的镇痛效果.方法 选取400例经阴道分娩的初产妇,按随机数字表法分为观察组200例和对照组200例.观察组采用新改良局部麻醉方法：侧切前采用9号针头在侧切口范围内紧贴皮肤下缘注射2％盐酸利多卡因3 mL,再由外向内注入2％盐酸利多卡因5mL局部浸润麻醉,缝合前加用2％盐酸利多卡因2 mL淋于阴道内伤口用于加强麻醉效果.对照组采用传统阴部神经阻滞局部麻醉法.结果 观察组在会阴伤口缝合时及术后2h内的伤口镇痛效果明显优于对照组（P=0.000）;观察组会阴侧切口Ⅰ期愈合率（96.0％）高于对照组（87.5％）（P=0.02）;观察组产后尿潴留发生率低于对照组（P=0.001）;2组新生儿出生1min及5 min Apgar评分差异无统计学意义（P＞0.05）.结论 新改良局部麻醉易于操作,镇痛效果明显优于传统方法,可减少产后尿潴留,极大减轻产妇痛苦,且不会增加对产妇及新生儿的危害.

Comparison of Two Methods of Topical Anesthesia for Episiotomy Suturing

Objective To compare the efficacies of two methods of local anesthesia for episiotomy suturing. Methods Four hundred primiparas who underwent vaginal delivery were randomly divided into two groups,with 200 primiparas in each group. In observation group,3 mL of 2% lidocaine hydrochloride was administered into the incision area through the skin edge with a 9-gauge needle. Then,5 mL of 2% lidocaine hydrochloride was injected from outside to inside for local infiltration anesthesia. Moreover, 2 mL of 2% lidocaine hydrochloride was used in vaginal wound to strengthen the anesthetic effect. In control group, topical anesthesia was induced by blocking the pudendal nerve. Results Compared with traditional pudendal nerve block, the modified local anesthesia improve the analgesic effect at the time of suturing perineum wound and within 2 hours after operation（P=0.000）, increased the stage I wound healing rate （96.0% vs 87.5%, P=0.02）, and reduced the incidence of postpartum urinary retention（P=0.001 ）. No significant differences in Apgar scores at one and five minutes in newborns were found between the two groups（P〉0.05）. Conclusion The modified technique for local anesthesia is easy to operate and has better analgesic effect than traditional method. Furthermore, the modified technique reduces postpartum urinary retention and relieves maternal pain without increased harm to mothers and newborns.