Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Effects of combined spinal-epidural anesthesia on anxiety,labor analgesia and motor blocks in women during natural delivery

BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.

Effects of Ropivacaine-sufentanil Epidural Analgesia on Labor and Maternal and Neonatal Outcomes

[Objectives]This study aimed to investigate the effects of ropivacaine-sufentanil epidural analgesia on labor and maternal and neonatal outcomes.[Methods]A total of 180 primiparas in full-term pregnancy were selected.They were randomly divided into treatment group(n=90)and control group(n=90).The primiparas in the treatment group were injected epidurally with ropivacaine and sufentanil for analgesia,and the primiparas in the control group were subjected to vaginal delivery.The VAS scores at 5,10,30 and 60 min of analgesia were observed.The vaginal bleeding amount,total labor duration,neonatal Apgar score and vaginal delivery rate of the two groups were compared.[Results]Compared with the control group,the VAS score in the treatment group differed insignificantly after 5 min of analgesia(P>0.05),and decreased significantly after 10,30 and 60 min of analgesia(P<0.05).The vaginal bleeding amount of the treatment group was significantly smaller than that of the control group(P<0.05).There was no significant difference in the neonatal Apgar score between the two groups(P>0.05).In the treatment group,the vaginal delivery rate increased(P<0.05),the second stage of labor was prolonged(P<0.05),and the first and third stages of labor did not change significantly(P>0.05).[Conclusions]Epidural analgesia with ropivacaine and sufentanil has a good analgesic effect and good safety,and is worthy of clinical promotion.

Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia

BACKGROUND For parturients with paroxysmal uterine contraction pain,rapid analgesia is needed.We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor,and evaluated the usefulness of this technique in epidural labor analgesia.AIM To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.METHODS In this prospective randomized observational study,72 parturients were assigned to two groups(combined or palpation group).The target interspace of all parturients was first identified by the palpation technique.Then in the combined group,preprocedure ultrasound imaging was used before epidural puncture.In the palpation group,only the traditional anatomical landmarks technique(palpation technique)was performed.The primary outcome was total duration of the epidural procedure(for the ultrasound group,the duration of the preprocedure ultrasound imaging was included).The secondary outcomes were the number of skin punctures,the success rate at first needle pass,the number of needle passes,the depth from the skin to epidural space,and the complications of the procedure.RESULTS Total duration of the epidural procedure was similar between the two groups(406.5±92.15 s in the combined group and 380.03±128.2 s in the palpation group;P=0.318).A significant improvement was demonstrated for epidural puncture and catheterization in the combined group.The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group(P=0.001).The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group(P=0.398).The success rate at first needle pass was 88.89%in the combined group and 66.67%in the palpation group(P=0.045).CONCLUSION This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique,which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Women’s Awareness and Attitudes towards Labor Analgesia Influencing Practice between Developed and Developing Countries

Childbirth experience is one of the most intense pain that majority of women will endure during their lifetime. Concerns about pain in labor remain a hot topic, and its popularity gets more common day by day as more women become aware of their rights to achieve a better quality of care during labor. There are various non-pharmacologic (transcutaneous electrical nerve stimulation, hydrotherapy, intradermal water injections and acupuncture) and pharmacologic treatments (nitrous oxide, opioids and regional analgesia techniques: spinal, epidural and combined epidural analgesia) available today. Among these, epidural analgesia offers the most effective form of pain relief and is considered to be the gold standard of labor analgesia. Despite having labor analgesic services, most women still go through painful labor due to lack of knowledge regarding it, particularly in developing countries. The main source of information regarding pain reliefs is from friends and relatives, revealing the lack of information from caregiver’s side. So this study reflects that there is a wide gap in the communication between pregnant women and obstetricians. It supports the fact that obstetricians through the practice of routinely offering labor analgesia can significantly improve the maternal and perinatal outcomes of pregnancy. Provision of standardized epidural analgesia information at an appropriate time in their pregnancy may benefit them by the practice of mutual decision-making. Thus, it may prevent women from making a difficult choice of cesarean section to avoid the fear of painful labor.

Comparison between 0.06% and 0.1% Levobupivacaine Combined with 2 μg/mL of Fentanyl for Epidural Labor Analgesia

Purpose: Levobupivacaine is thought to be a good alternative to bupivacaine for epidural labor analgesia because of its pharmacologic profile. However, the optimal concentration of levobupivacaine for labor analgesia has not been adequately studied. The objective of this retrospective study was to compare the analgesic effect of levobupivacaine between 0.06% and 0.1% both combined with 2 μg/mL of fentanyl. Methods: Primiparous women (ASA I, II) who delivered their babies to our hospital using combined spinal epidural analgesia and patient-controlled epidural analgesia between August 1, 2011 and September 30, 2011 were included into this retrospective study. The analgesic solution for epidural administration was 0.06% levobupivacaine with 2 μg/mL of fentanyl between August 1 and 31, and 0.1% levobupivacaine with 2 μg/mL of fentanyl between September 1 and 30. Their anesthetic and obstetric charts were reviewed to compare obstetric outcome, anesthetic intervention, and patients’ satisfaction. Results: There were 46 women fulfilling the inclusion criteria: 23 women in 0.06% group, and 23 women in 0.1% group. The number of patients who needed more than 3 requests for one actual bolus was significantly higher in the 0.06% group (P 0.05). Conclusion: Our results revealed that 0.06% levobupivacaine combined with 2 μg/mL fentanyl does not provide sufficient analgesic effects for epidural labor analgesia. It seems that levobupivacaine has not been adequately studied after its withdrawal from the US market. Further studies should be conducted to determine the optimal concentration of levobupivacaine for epidural labor analgesia.

Effects of labor analgesia on maternal and neonatal outcome by epidural low concentration of bupivacaine combined with anisodamine

Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar’s score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8%), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar’s score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocia and complications of delivery.

Effects of Different Modes of Labor Analgesia on Neonatal Neurobehavior

The term “painless delivery” originated from foreign countries and has a history of more than 100 years. It is actually called “childbirth analgesia” in medicine. Labor analgesia, as its name implies, is the use of various methods to reduce or even eliminate the pain during labor. With the development of anesthesiology and pain, it has been widely used in foreign countries, especially in some developed countries in the West. The rate of labor analgesia in the United States is > 85%, and even as high as 90% in Britain. The best childbirth analgesia should include side effect is small to puerpera and fetus, exact analgesic effect, quick effect, maintain time is long, can satisfy normal labor course;puerpera is awake, can cooperate childbirth and do not affect uterine contraction, and do not affect labor course progress. In 2000, WHO proposed that medical institutions should provide various labor analgesic services for parturient women to reduce labor pain as much as possible. Encourage the use of non-pharmaceutical analgesic techniques. In this paper, the effects of different modes of labor analgesia on neonates are described as follows.

A systematic Review of the Safety and Effectiveness of Epidural Analgesia for Labor Analgesia

Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.

分娩镇痛:舒适与安全并行,教学与质控并举

分娩镇痛是以遵循产妇自愿和临床安全为原则,通过实施有效的分娩镇痛技术,以最大程度减轻产妇产痛的医疗服务。2018年,北京协和医院成为我国分娩镇痛首批试点单位,近年来在分娩镇痛高质量发展的各项工作中取得了满意成果。本文主要介绍北京协和医院分娩镇痛相关经验,具体包括:(1)合理调配人员安排,多学科联动制定标准化诊疗流程,为安全分娩提供舒适度保障;(2)完善危重孕产妇、新生儿救治方案,为安全分娩保驾护航;(3)传递先进的教学理念,将分娩镇痛培训与救治演练落到实处;(4)开展教育与科普讲座,帮助产妇树立科学分娩镇痛观。希望该经验分享可为我国各级诊疗机构提供参考和借鉴。

硬膜外分娩镇痛产妇产间发热风险预测模型的构建与验证

目的:构建硬膜外分娩镇痛产妇产间发热(ERMF)风险预测模型并验证效果。方法:采用前瞻性研究方法,选取2022年1月—2022年7月于江苏省某三级甲等妇产医院产房接受硬膜外分娩镇痛的780名产妇为研究对象,根据是否诊断为ERMF分为ERMF组(n=148)与非ERMF组(n=632)。使用Logistic回归分析确定ERMF的独立危险因素,构建风险预测模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线与Hosmer-Lemeshow检验评价该模型的预测效能与拟合优度。选取2022年8月—10月住院的170名产妇作为模型的验证组,对预测模型进行验证。结果:建模组ERMF发生率为19.0%,验证组ERMF发生率20.6%。阴道指检次数、缩宫素使用、产程、胎膜破裂至分娩结束时间、罗哌卡因用量、舒芬太尼用量是ERMF的独立危险因素。预测模型的ROC曲线下面积为0.987,灵敏度为0.912,特异度为0.796,约登指数为0.888。验证组ROC曲线下面积为0.893,灵敏度为0.886,特异度为0.785。结论:该预测模型具有较好的区分度和校准度,对于识别高危ERMF产妇具有一定的预测价值,可以给临床护理工作提供一定的借鉴与参考,从而制定相应的护理措施以减少ERMF风险。

0.2%氯普鲁卡因联合罗哌卡因对硬膜外分娩镇痛效果及对罗哌卡因EC_(50)的影响

目的探讨0.2%氯普鲁卡因联合罗哌卡因对硬膜外分娩镇痛效果及对罗哌卡因半数有效浓度(EC_(50))的影响。方法选择2023年7月至10月在我院行阴道分娩且有镇痛需求的产妇67例,按随机数字表法分为RL组(33例)和R组(34例)。采用Dixon改良序贯法确定罗哌卡因的浓度。RL组产妇给予0.2%盐酸氯普鲁卡因注射液+盐酸罗哌卡因注射液+0.4μg/mL枸橼酸舒芬太尼注射液;R组产妇给予盐酸罗哌卡因注射液+0.4μg/mL枸橼酸舒芬太尼注射液。观察两组产妇的罗哌卡因EC_(50)、分娩镇痛效果、镇痛药总用量、镇痛满意度评分、不良反应发生情况、分娩情况及新生儿Apgar评分。结果RL组产妇的罗哌卡因EC_(50)、镇痛起效时间、补救镇痛率、会阴胀痛和爆发痛发生率、镇痛药总用量均显著低于R组,镇痛满意度评分显著高于R组(P<0.05);两组产妇的下肢麻木、下肢无力、寒战等不良反应发生率,产程时间、出血量、分娩方式及新生儿Apgar评分比较,差异均无统计学意义(P>0.05)。结论0.2%氯普鲁卡因联合罗哌卡因用于硬膜外分娩镇痛,可降低罗哌卡因的EC_(50),改善分娩镇痛效果,且安全性较好。

硬膜外分娩镇痛对产妇产后抑郁的影响

目的评估硬膜外分娩镇痛(LEA)对产妇产后抑郁(PPD)的影响。方法选择经阴道分娩的初产妇628例,年龄20~36岁,BMI 20~35 kg/m 2,ASAⅡ或Ⅲ级。根据产妇是否接受硬膜外分娩镇痛分为两组:镇痛组(n=322)和非镇痛组(n=306)。记录分娩期间VAS疼痛评分最高值、产程时间、出血量、新生儿1、5 min Apgar评分和新生儿入NICU的发生情况。于分娩前1周和产后2周、6周分别采用爱丁堡产后抑郁量表(EPDS)评估PPD发生情况(EPDS评分≥11分为PPD),采用广泛性焦虑量表(GAD-7)评估产妇焦虑情绪,采用领悟社会支持量表(PSSS)评估产妇感受到的总社会支持度。结果与非镇痛组比较,镇痛组产妇分娩期间VAS疼痛评分最高值明显降低(P<0.05)。两组产妇第一产程时间、第二产程时间、出血量、新生儿1、5 min Apgar评分、新生儿入NICU比例差异无统计学意义。两组产妇产后2、6周PPD发生率、PSSS高支持状态、GAD-7≥10分差异无统计学意义。结论初产妇接受LEA不影响产后抑郁的发生风险。

腰硬联合麻醉分娩镇痛后发热对母婴分娩结局的影响

目的探讨腰硬联合麻醉分娩镇痛后发热对分娩结局的影响,以期改善母婴结局。方法选取2020年1月至2022年6月进行腰硬联合麻醉分娩镇痛的300例产妇作为研究对象,根据镇痛后是否出现发热将产妇分为两组。对照组为未出现发热的产妇,共150例;观察组为出现发热的产妇,共150例。比较两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例、分娩方式、产妇不良结局发生率以及新生儿不良结局发生率。结果观察组阴道操作次数(7.56±1.12)次,破膜时间为(11.86±2.03)h,总产程时间为(17.08±2.34)h,使用缩宫素加强宫缩为51例(34.00%),对照组阴道操作次数(5.41±1.04)次,破膜时间为(8.69±1.75)h,总产程时间为(15.04±1.84)h,使用缩宫素加强宫缩为20例(13.33%),两组产妇的阴道操作次数、破膜时间、总产程时间、缩宫素使用比例等指标比较差异均有统计学意义(P<0.001)。观察组产妇自然分娩82例(54.67%),剖宫产45例(30.00%),器械助产23例(15.33%),对照组产妇自然分娩121例(80.67%),剖宫产19例(12.67%),器械助产10例(6.67%),两组产妇的分娩方式比较差异有统计学意义(P<0.05或0.001)。观察组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为60.67%(91/150),对照组产妇出现低血压、头痛、产后出血、产褥感染等总不良结局发生率为31.33%(47/150),两组产妇总不良结局发生率差异有统计学意义(P<0.001)。观察组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为40.67%(61/150),对照组出现胎儿窘迫、新生儿窒息、新生儿败血症、新生儿高胆红素血症等总不良结局发生率为22.67%(34/150),两组新生儿总不良结局发生率差异有统计学意义(P<0.001)。结论产时发热是一种临床表现,早发现早预防非常重要。对于产科医生而言,应加强产程管理,掌握阴道操作指征,严格遵循无菌操作,以预防感染性产时发热。同时,要避免产时发热相关因素的叠加,防止非感染性发热的发生。此外,还需综合分析产时发热的原因,动态监测各项指标,仔细鉴别,并采取适宜的产程处理措施。

椎管内分娩镇痛安全核查表的制订及其临床应用

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。

兵团南疆某三甲医院孕妇对椎管内分娩镇痛认知与服务需求调查

目的抽样调查就诊于兵团第一师医院孕妇对分娩镇痛的认知现状及服务需求,为更好推广分娩镇痛干预提供参考。方法便利抽样法抽取2021年10月-2022年6月在兵团第一师医院产科建卡的孕妇202例作为调查对象,参考国内相关文献自行编制《分娩镇痛认知及需求调查表》对其进行调查。结果参与调查的孕妇中,有80.9%的孕妇想象分娩痛是第一位疼痛,且有68.84%的孕妇认为分娩痛很恐怖;孕妇、家属对分娩镇痛排在前两位顾虑是:对胎儿、母亲的健康影响(44.22%、32.66%),也有32.66%的家属没有顾虑。63.32%的孕妇愿意接受分娩镇痛,84.92%的孕妇家属支持孕妇行分娩镇痛。有64.8%的孕妇对分娩镇痛不太了解,其中28.14%的孕妇完全不了解。有87.94%的孕妇愿意接受分娩镇痛相关培训,其中半数以上的孕妇更加愿意用线上的方式了解分娩镇痛相关知识。结论南疆地区孕妇对分娩镇痛有一定认知但了解程度不够。调查结果显示兵团南疆地区孕妇对分娩镇痛需求较大,但也有顾虑,通过借新媒介科普宣教相关知识而消除顾虑,更利于分娩镇痛推广。

北京地区12所二级以上医院助产士对分娩镇痛认知及支持度的调查研究

目的了解助产士对分娩镇痛相关知识的认知及支持度现状,为今后加强产妇宣教,促进工作实施提供数据支撑和方向。方法采用横断面调查方法,于2021年10~12月以微信推送问卷星链接的方法,对北京地区12所二级以上医院助产士发放分娩镇痛认知及支持度调查问卷。调查内容涉及人员结构、知识认知及工作支持等三类10个问题。结果共计回收127份有效问卷。受访者广泛分布于北京地区三级和二级公立及民营医疗机构。78.7%的受访者从事助产工作5年以上,且拥有护师以上职称。80.3%的受访者认为椎管内神经阻滞技术是效果最为切实可靠的分娩镇痛方法。助产士对采用椎管内神经阻滞技术行分娩镇痛主要疑虑集中在:影响产程(70.9%)、助产人员短缺(37.8%)、增加工作量(36.2%)。助产士最为担心麻醉药对产妇和/或胎儿呼吸的影响(75.6%)。尽管96.0%的助产士对椎管内神经阻滞分娩镇痛持支持态度,且有97.6%受访者希望达到更高比例,但仍有24.4%医疗机构,近3个月分娩镇痛比例不足40.0%。结论椎管内神经阻滞分娩镇痛效果确切且普遍为助产士接受。助产士对分娩镇痛的认知层面仍存有较多顾虑,加之人力不足可能一定程度限制了此项工作的推进,未来应加强宣教,扩充人力以促进工作更好开展。

产程护理联合非药物性镇痛分娩的效果及对妊娠结局的影响

目的探讨产程护理联合非药物性镇痛分娩的效果及对妊娠结局的影响。方法选取医院2022年5月至2023年5月收治的产妇90名,随机分为对照组和研究组,各45名。对照组产妇采用常规护理,研究组产妇采用产程护理联合非药物性镇痛分娩。结果研究组产程显著更短,自然分娩率显著更高,镇痛效果显著更好,不良事件发生率显著更低(P<0.05)。结论产程护理联合非药物性镇痛分娩可缩短产程,提升自然分娩率,降低产妇分娩的疼痛感知和不良事件发生率。

可行走性硬膜外分娩镇痛对高龄产妇临床分娩结局及产程时间、疼痛的影响价值分析

目的研究可行走性硬膜外分娩镇痛对高龄产妇的效果。方法选取2021年6月—2023年6月泰兴市人民医院收治的高龄产妇80例为研究对象,采用随机数表法分为。参照组(40例,常规分娩)和研究组(40例,可行走性硬膜外分娩镇痛)。对比两组焦虑自评量表(Self-rating Anxiety Scale,SAS)评分、疼痛数字评价量表(Numerical Rating Scale,NRS)评分、血清皮质醇(Cortisol,Cor)水平、血清泌乳素(Prolactin,PRL)水平、平均动脉压(Mean Artery Pressure,MAP)水平、异常胎心监护事件发生率、催产素使用率、产钳使用率、产程时间、产后出血量、阿氏(Apgar)评分。结果研究组镇痛0.5、1、2 h后的SAS、NRS评分均低于参照组,差异有统计学意义(P均<0.001)。镇痛2 h后,研究组的血清Cor水平较参照组更低,差异有统计学意义(P<0.05)。宫口开全时,研究组血清PRL水平比参照组更高,差异有统计学意义(P<0.05)。研究组宫口开3 cm时、宫口开10 cm时、胎儿娩出时的MAP水平,催产素使用率、产钳使用率,同参照组比较更低,差异有统计学意义(P均<0.05)。研究组母婴不良事件发生率为2.50%,比参照组的15.00%更低,差异有统计学意义(χ^(2)=3.614,P<0.05)。研究组的产程时间比参照组更短,差异有统计学意义(P<0.05)。两组异常胎心监护事件发生率、产后出血量、Apgar评分比较,差异无统计学意义(P均>0.05)。结论将可行走性硬膜外分娩镇痛,用于高龄产妇,可发挥良好的镇痛效果,并缩短产程,临床分娩结局更佳,且安全性良好。

低位水囊引产联合硬膜外分娩镇痛提高产妇经阴道分娩率的效果

目的探讨低位水囊引产联合硬膜外分娩镇痛提高产妇经阴道分娩率的效果。方法选取本院56例足月分娩产妇为研究对象,随机分为两组,各28例。对照组采用硬膜外分娩镇痛,试验组采用低位水囊引产联合硬膜外分娩镇痛,比较两组的产程用时、产后出血量、母婴不良结局及分娩情况。结果试验组第一产程、总产程用时短于对照组,产后24h出血量少于对照组,差异有统计学意义(P<0.05);试验组母婴不良结局发生率为3.57%,低于对照组的21.43%,差异有统计学意义(P<0.05);试验组经阴道分娩率为75.00%,高于对照组的57.14%,差异有统计学意义(P<0.05)。结论联合应用低位水囊引产与硬膜外分娩镇痛可以有效缩短产程,降低产后出血和母婴不良结局风险,提高经阴道分娩率。