硬膜外分娩镇痛产妇置管体验的质性研究

Qualitative Study on Experience in Catheter Placement for Epidural Labor Analgesia Among Lyingin Women

目的深入了解自然分娩产妇硬膜外阻滞置管的真实体验,旨在为临床制订针对性干预措施提供参考。方法采用目的抽样法,2022年7-8月选取于上海某三级甲等医院自然分娩并行硬膜外镇痛的12名产妇作为研究对象,进行面对面半结构式访谈,了解其对分娩镇痛及硬膜外置管的体验,采用Colaizzi七步法分析资料及提炼主题。结果硬膜外分娩镇痛产妇的麻醉置管体验包括负性体验和正性体验,同时希望提前了解硬膜外分娩镇痛相关知识。负性体验主要有:认为镇痛存在滞后性,置管前感到焦急与害怕,置管时因疼痛难以配合且无助、希望有家属陪伴,拔除导管后仍存在担心和顾虑;正性体验包括:认为使用镇痛药物后疼痛有效缓解有助于增加分娩信心、镇痛置管期间感受到医护人员的专业和关心。结论产科医护人员应关注硬膜外分娩镇痛产妇麻醉置管过程中的真实体验,及时了解其麻醉及分娩过程中的需求,并根据产妇个体情况合理选择硬膜外分娩镇痛时机和陪伴模式,以提高分娩质量。医院层面则应重视硬膜外分娩镇痛相关知识宣教,通过多种形式为孕产妇提供便捷、高效、专业的信息支持。

Objective To deeply understand the real experience in epidural catheter placement for anesthesia during spontaneous labor among lying‑in women,aiming to provide a reference for formulating targeted clinical intervention measures.Methods A total of 12 lying‑in women were selected by purposive sampling who underwent spontaneous labor and epidural analgesia in a GradeⅢ‑A hospital in Shanghai from July to August 2022.Face‑to‑face semi‑structured interviews were conducted to understand their experience in labor analgesia and epidural catheter placement.Their interview data was analyzed and refined using Colaizzi's seven‑step analysis method.Results The lying‑in women who underwent catheter placement for epidural labor analgesia had both negative and positive experiences,and they expressed a desire to acquire relevant knowledge about epidural labor analgesia in advance.Negative experiences:1)hysteresis in analgesia,2)anxiety and fearfulness before catheter placement,3)poor cooperation,sense of helplessness and desire for family accompaniment during catheter placement due to pain,and 4)ongoing worries and concerns after extubation.Positive experiences:1)effective pain relief after analgesia,thereby enhancing their confidence in delivery,and 2)perception of professionalism and compassionate attitude from healthcare providers during catheter placement for anesthesia.Conclusion Healthcare providers in the obstetrics department should pay attention to the real experience in catheter placement for epidural labor analgesia among lying‑in women.Moreover,healthcare providers should timely understand their needs during anesthesia and labor,and select the appropriate timing and accompanying mode of epidural labor analgesia according to individual conditions to improve the quality of labor.Hospitals should pay attention to the education of epidural analgesia‑related knowledge,and provide pregnant and lying‑in women with convenient,efficient and professional information support in various forms.