上海市分娩镇痛的现状调查
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摘要
目的调查上海市分娩镇痛的现状,为进一步推广普及分娩镇痛工作提供数据支持和决策依据。方法采用自制问卷,通过上海市医师协会麻醉科医师分会发布通知,对本研究目的及问卷填写进行说明与解释,借助"问卷星"网站平台实施问卷发放与回收。结果共调查58家医院,2017年分娩量占上海市分娩总量的90.44%,总体分娩镇痛率为37.22%。其中13家妇幼专科医院占58家医院分娩量的58.44%,分娩镇痛率为56.75%,占58家医院镇痛分娩量的93.50%。已开展分娩镇痛44家(75.86%),全部以椎管内阻滞为主要的分娩镇痛方法,其中42家(95.45%)在潜伏期开始镇痛,30家(68.18%)在分娩过程中会关闭镇痛泵,40家(90.9%)产妇满意度达85分以上,36家(81.82%)参照麻醉项目收费。未开展的14家医院中,有13家(92.86%)归因为麻醉科医师配备不足及其他相关因素。结论上海市分娩镇痛主要集中在妇幼专科医院。制约开展分娩镇痛的主要因素为麻醉科医师紧缺和没有专项收费标准。进一步推广普及分娩镇痛,除政策支持外,还应优化分娩镇痛流程、创新管理服务模式。
Objective To investigate the current situation of labor analgesia in Shanghai,provide data supportion and decision-making basis for further popularization of labor analgesia.Methods Using the self-made questionnaire,Shanghai Medical Doctor Association of Anesthesiologist issued a notice on the purpose of the study and the way how to fill it up.The questionnaire was distributed and recycled through the website wjx.com.Results The 58 hospitals included in this survey accounted for 90.44% of the total delivery in Shanghai in 2017,and the overall labor analgesia rate was37.22%.The number of deliveries in 13 maternal and child specialist hospitals accounted for 58.44%of 58 hospitals,and the labor analgesia rate was 56.75%.It accounted for 93.50%of the 58 hospitals analgesic deliveries.There are 44(75.86%)hospitals carrying labor analgesia by intraspinal nerve block as the main method of labor analgesia.42(95.45%)of these hospitals began to analgesia during the incubation period,30(68.18%)of these hospitals closed the analgesic pump during childbirth,and 40(90.9%)hospitals had a maternal satisfaction of 85 or more,36(81.82%)of these hospitals charged labor analgesia in accordance with the anesthesia clause.However,among the 14 hospitals that did not practive labor analgesia,13(92.86%)were due to inadequate anesthesiologists and other relevant factors.Conclusion The overall labor analgesia rate in Shanghai was 37.22%.The service has been mainly provided in maternal and child specialist hospitals.The main factors restricting the labor analgesia are the shortage of anesthesiologists and the lack of specific charges.In order to promote the labor analgesia,policy support is an important aspect,and the labor analgesia process and innovative management mode should also be optimized.
Objective To investigate the current situation of labor analgesia in Shanghai,provide data supportion and decision-making basis for further popularization of labor analgesia.Methods Using the self-made questionnaire,Shanghai Medical Doctor Association of Anesthesiologist issued a notice on the purpose of the study and the way how to fill it up.The questionnaire was distributed and recycled through the website wjx.com.Results The 58 hospitals included in this survey accounted for 90.44% of the total delivery in Shanghai in 2017,and the overall labor analgesia rate was37.22%.The number of deliveries in 13 maternal and child specialist hospitals accounted for 58.44%of 58 hospitals,and the labor analgesia rate was 56.75%.It accounted for 93.50%of the 58 hospitals analgesic deliveries.There are 44(75.86%)hospitals carrying labor analgesia by intraspinal nerve block as the main method of labor analgesia.42(95.45%)of these hospitals began to analgesia during the incubation period,30(68.18%)of these hospitals closed the analgesic pump during childbirth,and 40(90.9%)hospitals had a maternal satisfaction of 85 or more,36(81.82%)of these hospitals charged labor analgesia in accordance with the anesthesia clause.However,among the 14 hospitals that did not practive labor analgesia,13(92.86%)were due to inadequate anesthesiologists and other relevant factors.Conclusion The overall labor analgesia rate in Shanghai was 37.22%.The service has been mainly provided in maternal and child specialist hospitals.The main factors restricting the labor analgesia are the shortage of anesthesiologists and the lack of specific charges.In order to promote the labor analgesia,policy support is an important aspect,and the labor analgesia process and innovative management mode should also be optimized.
引文
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[7]Committee on Practice Bulletins-Obstetrics.Practice Bulletin No.177:Obstetric Analgesia and Anesthesia.Obstet Gynecol,2017,29(4):e73-e89.
[8]Ravangard R,Basiri A,Sajjadnia Z,et al.Comparison of the Effects of Using Physiological Methods and Accompanying a Doula in Deliveries on Nulliparous Womens Anxiety and Pain:A Case Study in Iran.Health Care Manager,2017,36(4):372-379.
[9]刘嘉,邱迪,谭萱,等.经皮神经电刺激分娩镇痛的疗效观察.暨南大学学报(自然科学与医学版),2016,37(5):416-419.
[10]赵继蓉,罗威,李胜华.穴位神经刺激联合患者自控硬脊膜外腔镇痛在潜伏期分娩镇痛中的应用.上海医学,2018,41(5):284-288.
[11]Wassen MM,Zuijlen J,Roumen FJ,et al.Early versus late epidural analgesia and risk of instrumental delivery in nulliparous women:a systematic review.BJOG,2011,118(6):655-661.
[12]Committee on Practice Bulletins-Obstetrics.Practice Bulletin No.177:Obstetric Analgesia and Anesthesia.Obstet Gynecol,2017,129(4):e73-e89.
[13]中华医学会麻醉学分会产科学组.分娩镇痛专家共识(2016版).临床麻醉学杂志,2016,32(8):816-818.
[14]李胜华,于布为.分娩镇痛现状与应对措施的思考.上海医学,2014,37(6):533-535.
[2]徐铭军,姚尚龙.中国分娩镇痛现状与对策.国际麻醉学与复苏杂志,2018,39(4):289-293,337.
[3]胡灵群,李韵平,夏云,等.从“无痛分娩中国行”看中国的分娩镇痛.临床麻醉学杂志,2013,29(2):205-208.
[4]姚尚龙,伍静.产科麻醉及分娩镇痛大有可为.中华麻醉学杂志,2016,36(11):1293-1294.
[5]Hu LQ,Flood P,Li Y,et al.No pain labor&delivery:a global health initiative's impact on clinical outcomes in China.Anesth Analg,2016,122(6):1931-1938.
[6]Hasegawa J,Farina A,Turchi G,et al.Effects of epidural analgesia on labor length,instrumental delivery,and neonatal short-term outcome.J Anesth,2013,27(1):43-47.
[7]Committee on Practice Bulletins-Obstetrics.Practice Bulletin No.177:Obstetric Analgesia and Anesthesia.Obstet Gynecol,2017,29(4):e73-e89.
[8]Ravangard R,Basiri A,Sajjadnia Z,et al.Comparison of the Effects of Using Physiological Methods and Accompanying a Doula in Deliveries on Nulliparous Womens Anxiety and Pain:A Case Study in Iran.Health Care Manager,2017,36(4):372-379.
[9]刘嘉,邱迪,谭萱,等.经皮神经电刺激分娩镇痛的疗效观察.暨南大学学报(自然科学与医学版),2016,37(5):416-419.
[10]赵继蓉,罗威,李胜华.穴位神经刺激联合患者自控硬脊膜外腔镇痛在潜伏期分娩镇痛中的应用.上海医学,2018,41(5):284-288.
[11]Wassen MM,Zuijlen J,Roumen FJ,et al.Early versus late epidural analgesia and risk of instrumental delivery in nulliparous women:a systematic review.BJOG,2011,118(6):655-661.
[12]Committee on Practice Bulletins-Obstetrics.Practice Bulletin No.177:Obstetric Analgesia and Anesthesia.Obstet Gynecol,2017,129(4):e73-e89.
[13]中华医学会麻醉学分会产科学组.分娩镇痛专家共识(2016版).临床麻醉学杂志,2016,32(8):816-818.
[14]李胜华,于布为.分娩镇痛现状与应对措施的思考.上海医学,2014,37(6):533-535.
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