肖金鳳 申恒春

[關(guān)鍵詞] 無(wú)痛分娩;剖宮產(chǎn)率;產(chǎn)程;新生兒結(jié)局

[中圖分類(lèi)號(hào)] R714.3? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-9701（2021）21-0184-04

New progress in application of painless delivery

XIAO Jinfeng1， 2? ?SHEN Hengchun1， 2

1.Department of Obstetrics and Gynecology， the Affiliated Hospital of Southwest Medical University， Luzhou? ?646000，China; 2.Department of Obstetrics and Gynecology， the First People's Hospital of Neijiang City in Sichuan Province，Neijiang? 641000， China

[Abstract] With the development of society and the advancement of medicine， the technology of painless childbirth has become more and more mature. In recent years， the declining birth rate and aging population of our country have become more and more serious. The implementation of the comprehensive second child policy has ushered in a small birth peak for obstetric medical workers. Painless delivery techniques have once again become the focus of attention. There are many existing painless delivery techniques， among which some have good analgesic effects but with many complications， and some have few complications but with poor analgesic effects. The current situation has prompted a pursuit for more effective methods of labor analgesia. This paper reviews the relevant clinical data， summarizes the new progress in the clinical application of painless delivery techniques， and discusses the effectiveness of various painless delivery techniques， their impact on the prognosis of mothers and infants， and the prospects for future development.

[Key words] Painless delivery; Cesarean section rate; Labor process; Neonatal outcome

每一個(gè)新生命的誕生都伴隨著母親的產(chǎn)痛，如何減輕或消除這種疼痛是近百年來(lái)產(chǎn)科醫(yī)務(wù)人員不斷奮進(jìn)的目標(biāo)。在醫(yī)學(xué)疼痛指數(shù)中，燒灼傷痛位于第一，產(chǎn)痛位于第二，分娩時(shí)的疼痛使產(chǎn)婦焦慮、情緒緊張，食量下降，宮縮乏力導(dǎo)致產(chǎn)程延長(zhǎng)等[1]。分娩應(yīng)激的主要原因是產(chǎn)時(shí)疼痛，過(guò)度的心理應(yīng)激和生理應(yīng)激對(duì)母親和胎兒均不利。產(chǎn)時(shí)的焦慮和緊張的情緒進(jìn)一步加重疼痛反應(yīng)，過(guò)度換氣可致母兒酸堿平衡紊亂，引起胎兒窘迫等[2]。在我國(guó)社會(huì)人口老齡化日益嚴(yán)重、全面二胎政策下，無(wú)痛分娩再次被推上醫(yī)學(xué)熱搜。本文就無(wú)痛分娩技術(shù)的新進(jìn)展綜述如下。

1分娩疼痛的作用機(jī)制及特點(diǎn)

分娩疼痛是產(chǎn)婦分娩過(guò)程中產(chǎn)生的一種復(fù)雜的生理心理活動(dòng)，疼痛級(jí)別高、持續(xù)時(shí)間長(zhǎng)，對(duì)分娩會(huì)造成極為不利的影響。產(chǎn)婦分娩疼痛的機(jī)制相對(duì)比較復(fù)雜，不同產(chǎn)程時(shí)疼痛原因不同。在第一產(chǎn)程，宮縮時(shí)使子宮肌肉缺血缺氧產(chǎn)生的疼痛感和宮頸擴(kuò)張時(shí)肌肉過(guò)度牽拉產(chǎn)生的疼痛感構(gòu)成了第一產(chǎn)程疼痛的主要來(lái)源。由10、11、12胸神經(jīng)后段通過(guò)交感神經(jīng)傳遞到脊髓。在第二產(chǎn)程，疼痛除了宮縮時(shí)使子宮肌肉缺血缺氧產(chǎn)生的疼痛感，還包含來(lái)自胎頭對(duì)盆底組織的壓迫，通過(guò)2、3、4骶神經(jīng)的感覺(jué)纖維傳遞至脊髓。另外，產(chǎn)婦焦慮、緊張可導(dǎo)致害怕-緊張-疼痛綜合征[3]。對(duì)于部分胎位異常者和高齡產(chǎn)婦會(huì)陰陰道彈性降低者，所受到的刺激比適齡產(chǎn)婦更強(qiáng)，產(chǎn)程相對(duì)更長(zhǎng);對(duì)于部分疼痛閾值低的產(chǎn)婦，輕微刺激即可感知疼痛，在分娩過(guò)程中感知的疼痛程度相比嚴(yán)重[4]。

2無(wú)痛分娩的應(yīng)用時(shí)機(jī)

產(chǎn)婦臨產(chǎn)后有鎮(zhèn)痛需求，在排除生殖器畸形、骨盆狹窄等陰道試產(chǎn)禁忌證后，確定胎心正常，簽署知情同意書(shū)后，由專(zhuān)業(yè)的人員實(shí)施無(wú)痛分娩技術(shù)。

3無(wú)痛分娩的鎮(zhèn)痛方法

3.1非藥物鎮(zhèn)痛法

多以安慰為主，包括心理和精神。主要有呼吸鎮(zhèn)痛法、精神鎮(zhèn)痛法、針刺鎮(zhèn)痛法、導(dǎo)樂(lè)分娩鎮(zhèn)痛法、自由體位分娩法等。