J Obstet Gynecol Neonatal Nurs. 2020 Nov;49(6):507-524. doi: 10.1016/j.jogn.2020.09.155. Epub 2020 Oct 21.
To describe the incidence, health effects, risk factors, and practice implications of lower extremity nerve injury (LENI) related to vaginal births.
We searched MEDLINE, CINAHL, and PubMed from 2000 to 2020 for peer-reviewed published case reports and research studies of LENI related to vaginal births.
We identified 188 potential records, and 20 met inclusion criteria (six research studies and 14 case studies).
Three independent reviewers extracted details of injuries and births into an Excel spreadsheet and analyzed data using SPSS.
Using birth data from each case study and from four of the six research articles, we found the incidence of LENI in vaginal births was 0.3% to 1.8%. The description of health effects includes affected nerves and the location, description, and duration of symptoms. Analyses of risk factors were limited by missing birth data (length of second stage, birth weight, etc). Vaginal births with LENI were 76% spontaneous, 77% with neuraxial anesthesia, and 64% first vaginal birth. Practice implications focused on prevention through specific positioning strategies. Despite nurses being the primary caregivers during labor, LENI was reported most often in anesthesia journals with virtually no reports in nursing journals.
LENI is a potential complication of vaginal birth, and little published research is available on prevention and prognosis. While obstetric and anesthesia factors can cause or contribute to nerve injury, LENI is usually caused by positioning and is considered preventable. Care recommendations include the following: avoid prolonged hyperflexion of women's thighs and knees; minimize time in lithotomy, squatting, or kneeling positions; prevent hand or other deep pressure on lateral knee and posterior thigh areas; avoid motor-blocking neuraxial (epidural) anesthesia; and implement frequent repositioning. The paucity of literature contributes to the lack of awareness of LENI among clinicians.
描述与阴道分娩相关的下肢神经损伤（LENI）的发生率、健康影响、危险因素和实践意义。
我们检索了 2000 年至 2020 年 MEDLINE、CINAHL 和 PubMed 上与阴道分娩相关的 LENI 的同行评审发表的病例报告和研究。
我们确定了 188 份潜在记录，其中 20 份符合纳入标准（6 项研究和 14 项病例研究）。
三位独立评审员将损伤和分娩的详细信息提取到 Excel 电子表格中，并使用 SPSS 分析数据。
使用每个病例研究和六篇研究文章中的四篇的分娩数据，我们发现 LENI 在阴道分娩中的发生率为 0.3%至 1.8%。健康影响的描述包括受影响的神经以及症状的位置、描述和持续时间。对危险因素的分析受到分娩数据缺失的限制（第二产程长度、出生体重等）。有 LENI 的阴道分娩 76%为自发性，77%采用脊麻麻醉，64%为首次阴道分娩。实践意义侧重于通过特定的定位策略进行预防。尽管护士是分娩期间的主要护理人员，但 LENI 报告最多的是麻醉期刊，而护理期刊几乎没有报告。
LENI 是阴道分娩的潜在并发症，关于预防和预后的研究很少。虽然产科和麻醉因素会导致或促成神经损伤，但 LENI 通常是由定位引起的，并且可以预防。护理建议包括：避免女性大腿和膝盖过度弯曲；尽量减少截石位、蹲位或跪位的时间；防止手或其他深部压力施加于膝盖外侧和大腿后侧；避免使用阻滞运动的脊麻（硬膜外）麻醉；并实施频繁的体位变换。文献的缺乏导致临床医生对 LENI 的认识不足。
