椎管内分娩镇痛安全核查表的制订及其临床应用

Development and Clinical Application of Analgesic Safety Check Table for Intraspinal Labor

目的制订椎管内分娩镇痛安全核查表,积极探索其临床应用的效果;建立椎管内分娩镇痛安全实施策略,保障母儿安全。方法选取东南大学附属中大医院2020年1月—2021年12月实施椎管内分娩镇痛的1072例产妇作为观察组,与2018年1月—2019年12月实施椎管内分娩镇痛的850例产妇作为对照组进行回顾性比较。对照组采取椎管内分娩镇痛常规操作流程,观察组在采取常规流程的基础上,应用东南大学附属中大医院制订的椎管内分娩镇痛安全核查表对椎管内分娩镇痛的各环节进行核查。对比2组产妇椎管内分娩镇痛常见并发症、产妇分娩结局等发生情况,对比2组新生儿不良结局的发生情况,对比2组医务人员在椎管内分娩镇痛各环节操作流程的执行力情况。结果2组产妇椎管内分娩镇痛常见麻醉并发症发生率比较,对照组产时发热发生率为11.18%,观察组为8.21%;对照组尿潴留发生率为10.94%,观察组为6.25%,差异有统计学意义(P<0.05)。2组产妇剖宫产及自然分娩情况比较,对照组剖宫产率为9.53%,观察组为6.06%;对照组自然分娩率为89.65%,观察组为93.47%,差异有统计学意义(P<0.05)。产妇对椎管内分娩镇痛满意度情况的比较,对照组总满意度为98.71%,观察组为99.81%;差异有统计学意义(P<0.05)。2组胎儿窘迫发生情况的比较,差异有统计学意义(P<0.05)。干预前后医务人员操作流程执行规范性的比较,差异有统计学意义(P<0.05)。结论椎管内分娩镇痛安全核查表可有效降低东南大学附属中大医院中转剖宫产率及母儿并发症的发生率,提高医务人员在椎管内分娩镇痛各环节执行的规范性,普及镇痛条件下的自然分娩,推进国内现代化产房的建设,提高孕产妇及家庭的幸福感及满意度。

Objective To develop a safety checklist for intraspinal labor analgesia and explore its clinical application.To establish the safe implementation strategy of intraspinal labor analgesia to ensure the safety of mother and child.Methods A total of 1072 parturients who received intraspinal labor analgesia in Zhongda Hospital of Southeast University from January 2020 to December 2021 were selected as the observation group,and 850 parturients who received intraspinal labor analgesia from January 2018 to December 2019 were selected as the control group for retrospective comparison.Control group taked on the labor analgesia routine operation,observation group in the basis of the conventional process and application in Zhongda Hospital of Southeast University for labor analgesia intra-spinal canal safety check list to inspect each link of labor analgesia intra-spinal canal.The incidence of common complications of intraspinal labor analgesia and maternal delivery outcomes were compared between the two groups,the incidence of adverse neonatal outcomes was compared between the two groups,and the executive ability of medical staff in each link of intraspinal labor analgesia was compared between the two groups.Results The incidence of common anesthesia complications was compared between the two groups.The incidence of intrapartum fever was 11.18% in the control group and 8.21% in the observation group.The incidence of urinary retention was 10.94% in control group and 6.25% in observation group.The difference was statistically significant(P<0.05).The cesarean section rate was 9.53% in the control group and 6.06% in the observation group.The natural delivery rate was 89.65% in the control group and 93.47% in the observation group.The difference was statistically significant(P<0.05).The total satisfaction of the control group was 98.71% and the observation group was 99.81%.The difference was statistically significant(P<0.05).There was statistical significance in the occurrence of fetal distress between the two groups(P<0.05).There was statistical significance in the standardization of operation procedures before and after intervention(P<0.05).Conclusion The safety checklist for intraspinal labor analgesia can effectively reduce the rate of cesarean section and the incidence of maternal and child complications in our hospital,improve the standardization of medical staff in the implementation of each link of intraspinal labor analgesia,populalize natural childbirth under analgesic conditions,promote the construction of modern delivery rooms in China,and improve the happiness and satisfaction of pregnant women and their families.It is worthy of clinical promotion.