无痛分娩的应用新进展

肖金凤 申恒春

[关键词] 无痛分娩;剖宫产率;产程;新生儿结局

[中图分类号] R714.3          [文献标识码] A          [文章编号] 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

每一個新生命的诞生都伴随着母亲的产痛，如何减轻或消除这种疼痛是近百年来产科医务人员不断奋进的目标。在医学疼痛指数中，烧灼伤痛位于第一，产痛位于第二，分娩时的疼痛使产妇焦虑、情绪紧张，食量下降，宫缩乏力导致产程延长等[1]。分娩应激的主要原因是产时疼痛，过度的心理应激和生理应激对母亲和胎儿均不利。产时的焦虑和紧张的情绪进一步加重疼痛反应，过度换气可致母儿酸碱平衡紊乱，引起胎儿窘迫等[2]。在我国社会人口老龄化日益严重、全面二胎政策下，无痛分娩再次被推上医学热搜。本文就无痛分娩技术的新进展综述如下。

1分娩疼痛的作用机制及特点

分娩疼痛是产妇分娩过程中产生的一种复杂的生理心理活动，疼痛级别高、持续时间长，对分娩会造成极为不利的影响。产妇分娩疼痛的机制相对比较复杂，不同产程时疼痛原因不同。在第一产程，宫缩时使子宫肌肉缺血缺氧产生的疼痛感和宫颈扩张时肌肉过度牵拉产生的疼痛感构成了第一产程疼痛的主要来源。由10、11、12胸神经后段通过交感神经传递到脊髓。在第二产程，疼痛除了宫缩时使子宫肌肉缺血缺氧产生的疼痛感，还包含来自胎头对盆底组织的压迫，通过2、3、4骶神经的感觉纤维传递至脊髓。另外，产妇焦虑、紧张可导致害怕-紧张-疼痛综合征[3]。对于部分胎位异常者和高龄产妇会阴阴道弹性降低者，所受到的刺激比适龄产妇更强，产程相对更长;对于部分疼痛阈值低的产妇，轻微刺激即可感知疼痛，在分娩过程中感知的疼痛程度相比严重[4]。

2无痛分娩的应用时机

产妇临产后有镇痛需求，在排除生殖器畸形、骨盆狭窄等阴道试产禁忌证后，确定胎心正常，签署知情同意书后，由专业的人员实施无痛分娩技术。

3无痛分娩的镇痛方法

3.1非药物镇痛法

多以安慰为主，包括心理和精神。主要有呼吸镇痛法、精神镇痛法、针刺镇痛法、导乐分娩镇痛法、自由体位分娩法等。