無痛分娩的應用新進展

肖金鳳 申恒春

[關鍵詞] 無痛分娩;剖宮產率;產程;新生兒結局

[中圖分類號] R714.3? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 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

每一個新生命的誕生都伴隨著母親的產痛，如何減輕或消除這種疼痛是近百年來產科醫(yī)務人員不斷奮進的目標。在醫(yī)學疼痛指數中，燒灼傷痛位于第一，產痛位于第二，分娩時的疼痛使產婦焦慮、情緒緊張，食量下降，宮縮乏力導致產程延長等[1]。分娩應激的主要原因是產時疼痛，過度的心理應激和生理應激對母親和胎兒均不利。產時的焦慮和緊張的情緒進一步加重疼痛反應，過度換氣可致母兒酸堿平衡紊亂，引起胎兒窘迫等[2]。在我國社會人口老齡化日益嚴重、全面二胎政策下，無痛分娩再次被推上醫(yī)學熱搜。本文就無痛分娩技術的新進展綜述如下。

1分娩疼痛的作用機制及特點

分娩疼痛是產婦分娩過程中產生的一種復雜的生理心理活動，疼痛級別高、持續(xù)時間長，對分娩會造成極為不利的影響。產婦分娩疼痛的機制相對比較復雜，不同產程時疼痛原因不同。在第一產程，宮縮時使子宮肌肉缺血缺氧產生的疼痛感和宮頸擴張時肌肉過度牽拉產生的疼痛感構成了第一產程疼痛的主要來源。由10、11、12胸神經后段通過交感神經傳遞到脊髓。在第二產程，疼痛除了宮縮時使子宮肌肉缺血缺氧產生的疼痛感，還包含來自胎頭對盆底組織的壓迫，通過2、3、4骶神經的感覺纖維傳遞至脊髓。另外，產婦焦慮、緊張可導致害怕-緊張-疼痛綜合征[3]。對于部分胎位異常者和高齡產婦會陰陰道彈性降低者，所受到的刺激比適齡產婦更強，產程相對更長;對于部分疼痛閾值低的產婦，輕微刺激即可感知疼痛，在分娩過程中感知的疼痛程度相比嚴重[4]。

2無痛分娩的應用時機

產婦臨產后有鎮(zhèn)痛需求，在排除生殖器畸形、骨盆狹窄等陰道試產禁忌證后，確定胎心正常，簽署知情同意書后，由專業(yè)的人員實施無痛分娩技術。

3無痛分娩的鎮(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、導樂分娩鎮(zhèn)痛法、自由體位分娩法等。