信息化技术支撑多学科协作分娩镇痛管理模式的可行性研究  

Feasibility of information-supported multi-disciplinary labor analgesia management model

作　　者：张丽峰 罗威[1] 李胜华[1] 刘艳 沈彩琴[2] 杨立新[3] ZHANG Lifeng;LUO Wei;LI Shenghua;LIU Yan;SHEN Caiqin;YANG Lixin(Department of Anesthesiology,Jiading Maternal and Child Health Hospital,Shanghai 201821,China;不详)

机构地区：[1]上海市嘉定区妇幼保健院麻醉科,上海201821 [2]上海市嘉定区妇幼保健院产房,上海201821 [3]上海市嘉定区妇幼保健院产科,上海201821

出　　处：《上海医学》2020年第11期675-679,共5页Shanghai Medical Journal

基　　金：上海市嘉定区科学技术委员会农业和社会事业科研项目(JDKW-2018-W19);上海市嘉定区卫生计生系统新一轮医学重点学科项目(2017ZD08)。

摘　　要：目的探讨信息化技术支撑多学科协作分娩镇痛管理模式的可行性。方法选择在上海市嘉定区妇幼保健院行镇痛分娩的360例产妇开展前瞻性队列研究。将2018年1-6月间分娩的产妇纳入对照组;2018年8月医院完成产房信息化建设,将2018年9月-2019年3月间分娩的产妇纳入试验组,每组180例。两组产妇均常规监测心率、血压、心电图和胎心率(FHR),在临产(出现规律宫缩、宫颈管消失)且产妇要求镇痛时行硬膜外镇痛。选择L 3至L 4椎间隙行穿刺置管,予0.075%罗哌卡因+0.5μg/mL舒芬太尼镇痛,镇痛模式为程序化间断硬膜外给药复合患者自控硬膜外镇痛。试验组产妇通过信息化技术在移动终端即时反馈疼痛VAS评分,信息化系统实时获取产妇的生命体征、胎心监护图形并自动分析,超过预设值时发出警报,使麻醉科医师、产科医师、麻醉科护士和助产士可随时查看并处理。对照组产妇以常规方式进行观察和处理。结果试验组镇痛分娩期间疼痛VAS评分最高值和疼痛VAS评分≥7分的产妇比例,出现第Ⅱ类胎心监护图形的持续时间、第Ⅲ类胎心监护图形的例数均显著低于对照组(P值均<0.05);试验组产妇和医护人员的满意度均显著高于对照组(P值均<0.05)。两组产妇的一般情况、产程时长、分娩方式、产后2 h内出血量、新生儿窒息发生率的差异均无统计学意义(P值均>0.05)。结论信息化技术支撑多学科协作分娩镇痛管理模式能改善产妇的分娩镇痛效果,及时发现异常胎心监护图形,提高产妇和医护人员的满意度。Objective To explore the feasibility of information-supported multi-disciplinary labor analgesia management model.Methods A total of 360 parturients who required analgesic delivery were enrolled in this prospective cohort study.Women who gave birth between Jan.2018 and Jun.2018 were assigned to the control group.After the construction of the information-supported labor analgesia management system in Aug.2018,women who gave birth between Sept.2018 and Mar.2019 were assigned to the study group,with 180 cases in each group.When they had regular contractions and cervix regression and required analgesia,anesthesiologists performed epidural analgesia through L3-L4 intervertebral space,and analgesics(0.075% ropivacaine and 0.5μg/mL sufentanil)were injected through an epidural catheter with a model of programmed intermittent epidural bolus(PIEB)plus patient control epidural analgesia(PCEA).The information-supported labor analgesia management system allowed the maternal to feedback the visual analogue scale(VAS)through the mobile terminal in a real time manner.The system could automatically analyze the fetal heart rate(FHR)tracings.When the Category Ⅱ or Category Ⅲ FHR tracings appeared,the alarm was issued.The VAS score,maternal vital signs,FHR tracings and other information were displayed in a centralized manner,medical staff such as anesthesiologists,obstetricians,anesthesia nurses,and midwives could check at any time.The control group was observed and treated with routine methods.Results The highest pain VAS score,the proportion of VAS scores≥7 and Category Ⅲ FHR tracings in study group were significantly lower,the duration of Category Ⅱ was significantly shorter than that in the control group(all P<0.05),and the satisfaction rates of maternal and medical staff were significantly higher than the control group(all P<0.05).There were no significant differences in demographics,the duration of the first and second stage of labor,delivery mode,postpartum hemorrhage within 2 hours,or the incidence of neonatal asp

关 键 词：信息化分娩镇痛管理系统 硬膜外分娩镇痛 疼痛VAS评分 电子胎心监护 前瞻性队列研究 

分 类 号：R714.3[医药卫生—妇产科学]