初产妇与经产妇分娩恐惧及疼痛强度的比较研究

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas:A cross-sectional study

目的描述初产妇与经产妇分娩恐惧和产时疼痛强度的特点并比较差异,探讨实际疼痛缓解情况与分娩恐惧的关系。方法采用便利抽样法,2018年2月至2019年8月选取广州市某三级甲等专科医院自然临产或引产的阴道分娩产妇共260名,其中初产妇97名,经产妇163名。从结构化电子病历系统提取产妇和新生儿的临床资料,通过问卷收集其他一般资料,如职业、家庭人均月收入。采用数字评定量表(the Numeric Rating Scale,NRS)和中文版分娩态度问卷(the Chinese version of the Childbirth Attitude Questionnaire,C-CAQ)对产妇分娩时疼痛程度和分娩恐惧程度进行评估。产妇的产时麻醉药消耗量和手动按压补充给药次数从自控硬膜外镇痛泵查看并记录。结果82名(84.5%)初产妇和99名(60.7%)经产妇接受了硬膜外自控镇痛方式(P<0.001)。在采用硬膜外镇痛组中,初产妇分娩恐惧得分高于经产妇(36.46±10.93比32.06±10.23,P=0.007)。然而,经产妇分娩时疼痛得分[8.0(8.0,9.0)比8.0(7.0,8.0)]、每小时成功手动补充给药次数[2.68(1.65,3.85)比1.77(0.90,2.47)]、每小时麻醉药消耗剂量[23.00(16.00,28.25)比17.24(11.52,21.36)]mL、平均每公斤消耗麻醉药剂量依次为[0.35(0.24,0.45)比0.26(0.19,0.35)]mL/kg均高于初产妇(P<0.05)。Spearman相关分析显示,分娩疼痛最大值与分娩恐惧之间呈弱相关(r=0.09),与每小时麻醉药消耗量(r=0.16)和平均每公斤体重麻醉药消耗量(r=0.17)呈正相关(P<0.01)。麻醉药物消耗量与产妇的分娩恐惧得分无相关性。结论分娩恐惧是产时疼痛程度的潜在预测因素。产次并不是镇痛需求的决定性因素,特别是在资源有限的情况下,产科医护团队不应紧依靠产次来分配镇痛资源。

Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.