区域内管理体系下分娩镇痛开展情况的分析

Analysis of Labor Analgesia Under Regional Management System

目的探索建立闵行区分娩镇痛管理体系,为孕产妇提供优质安全的助产服务。方法调查区域内所有助产医疗机构分娩情况,对比分析分娩镇痛管理体系建立前后全区分娩镇痛率和剖宫产率的变化以及在区域内管理体系下2019—2020年区内阴道产产妇中分娩镇痛与非镇痛的新生儿窒息率、产后出血率。结果(1)2018年全区分娩镇痛率16.76%,管理体系实施后2019年、2020年分娩镇痛率分别为35.22%和44.36%;2018年、2019年、2020年全区剖宫产率率分别为43.58%、44.17%、44.47%。(2)2019—2020年9527例阴道分娩产妇中分娩镇痛与非镇痛的母婴安全相关指标:①全区总分娩镇痛产后出血率7.07%,非镇痛组产后出血率9.27%,差异有统计学意义(P<0.01)。②全区分娩镇痛新生儿窒息率为0.43%,非镇痛为0.67%,χ^(2)=2.389,P>0.05,差异无统计学意义。结论区域内实施分娩镇痛管理体系可明显提高分娩镇痛率,促进产科建设,虽未降低剖宫产率和新生儿窒息率,但减少了产后出血率,有益于探索并推广精细化管理经验,提高产科服务能力,使分娩更安全。

Objectives To explore the establishment of the labor analgesia management system in Minhang District to provide high-quality and safe midwifery services for pregnant women.Methods To investigate the changes of obstetric construction and labor analgesia rate before and after the establishment of labor analgesia management system in Minhang District,and compare and analyze the neonatal asphyxia rate and postpartum hemorrhage rate of labor analgesia and non labor analgesia in 6 midwifery medical institutions in Minhang District from 2019-2020.Results(1)The labor analgesia rate in 2018 was 16.76%.After the implementation of the management system,the labor analgesia rates in 2019and 2020 were 35.22%and 44.36%,respectively;the cesarean section rates in 2018,2019 and 2020 were 43.58%,44.17%and 44.47%,respectively.(2)In 9527 cases of vaginal delivery from 2019-2020,the maternal and infant safety-related indicators of labor analgesia and non-analgesia:①The total postpartum hemorrhage rate of labor analgesia in the whole region was 7.07%,which was lower than 9.27%in the non-analgesia group,and the difference was statistically significant(P<0.01).②The neonatal asphyxia rate of labor analgesia was 0.48%,and that of non-analgesia was 0.67%,χ^(2)=2.389,P>0.05.Conclusion Implementation of the labor analgesia management system in the region can significantly improve the labor analgesia rate and promote the construction of obstetrics.Although it does not reduce the rate of cesarean section to learn from and neonatal asphyxia,it can reduce the rate of postpartum hemorrhage.It is beneficial each other,explore and promote fine management experience of the labor process in the region,improve the ability of obstetrics service and make delivery safer.