【摘要】 目的回顾分析足月自然产会阴侧切开术和会阴裂伤对产后的影响。方法北京宣武医院2012年1月至12月182例足月孕妇会阴侧切开术92例和会阴裂伤90例,比较伤口出血量和手术时间,切口延伸、愈合率和裂开,伤口肿胀、触痛和硬结,采用视觉模拟评分法(VAS)评估术中、术后疼痛和产痛的比较,产后日常活动对母乳喂养的影响,产后盆底的检查。结果①伤口出血量裂伤组低于侧切组,差异有统计学意义[(33.2±6.0)ml vs(53.2±8.8)ml,P<0.05];缝合时间裂伤组短于侧切组,差异有统计学意义[(13.2±3.0)min vs(16.2±2.2)min,P<0.05];②切口延伸、伤口愈合率和裂开两组差异无统计学意义(P>0.05);产后会阴伤口肿胀(38%vs 22.2%)、触痛(63.8%vs 17.8%)、硬结(53.3%vs 12.2%),会阴侧切组明显高于会阴裂伤组,差异有统计学意义(P<0.01);③侧切组术后疼痛VAS评分比裂伤组高,差异有统计学意义(P<0.05),术中疼痛和产痛两组差异无统计学意义(P>0.05),两组均表现为产痛>术后疼痛>术中疼痛。术后疼痛对产妇影响依次坐、行、排便、睡眠、排尿、翻身活动;④产后母乳喂养会阴侧切组在产后第3天100%母乳喂养,裂伤组产后第2天100%母乳喂养,差异有统计学意义(P<0.05);⑤产后盆底的检查两组比较差异无统计学意义(P>0.05)。结论会阴切开术没有降低损伤的发生,反而增加产后疼痛。更多还原

【Abstract】 Objective To observe the influence of episiotomy and perineal laceration on postpartum.Methods 182cases of full-term pregnant women who underwent vaginal delivery with episiotomy(92cases)or perineal laceration(90cases)from Jan to Dec 2012were recruited in this study.The amount of bleeding,perineal wound swelling,tenderness and induration,the intraoperative and postoperative visual analog scale(VAS),postpartum daily activities and postpartum breastfeeding were compared between the two groups.Results ① The amount of bleeding in laceration group was lower than episiotomy group [(33.2±6.0)ml vs(53.2±8.8)ml,P<0.05)];the suture time of laceration group was shorter than episiotomy group [(13.2±3.0)min vs(16.2±2.2)min,P<0.05)]; ② The rate of incision extending,wound healing and wound dehiscence of the two groups had no statistically difference(P>0.05);Postpartum perineum wound swelling,perineal tenderness and perineal scleroma in episiotomy group were more serious than that in laceration group(P<0.05);③ Postoperative pain VAS score in episiotomy group was higher than that in laceration group(P<0.05);④ Women in episiotomy group begun breast-feeding on the third day of postpartum while those in perineal laceration group begun on the second day(P<0.05);⑤ Postpartum pelvic examination finding had no statistical significance in the two groups(P>0.05).Conclusion Episiotomy does not reduce the perineal injury occurrence,instead it may increase postpartum pain and delay breastfeeding.更多还原