分娩镇痛信息化管理系统的临床应用效果  

Clinical effectiveness of information management system for labor analgesia

作　　者：张丽峰 罗威[1] 李胜华[1] 黄露萍 王长社[1] 赵继蓉[1] ZHANG Lifeng;LUO Wei;LI Shenghua;HUANG Luping;WANG Changshe;ZHAO Jirong(Department of Anesthesiology,Jiading Maternal and Child Health Hospital,Shanghai 201821,China)

机构地区：[1]上海市嘉定区妇幼保健院麻醉科,201821

出　　处：《临床麻醉学杂志》2020年第12期1153-1156,共4页Journal of Clinical Anesthesiology

基　　金：上海市嘉定区科委基金项目(JDKW-2018-W19);上海市嘉定区卫生计生系统新一轮医学重点学科(2017ZD08)。

摘　　要：目的观察分娩镇痛信息化管理系统在产科的临床应用效果,并与应用前进行对比分析。方法选择单胎、头位、有镇痛需求的初产妇425例,宫内孕37~40周,年龄22~30岁,BMI 22~28 kg/m^2,ASAⅡ级,其中2018年1—6月分娩的产妇为对照组(n=213),2018年8月完成信息化分娩镇痛管理系统建设,2019年1—6月分娩的产妇为研究组(n=212)。两组产妇均选择L 3-4椎间隙穿刺置管,镇痛药配方为0.075%罗哌卡因+0.5μg/ml舒芬太尼,镇痛模式为程控脉冲给药+自控给药。研究组产妇可以通过iPainfree TM镇痛管理系统进行反馈,若VAS疼痛评分≥4分或半小时内自控按压≥2次,麻醉科医师给予补救镇痛。主要观察指标为分娩镇痛期间最高VAS疼痛评分和VAS疼痛评分≥7分的比例。次要指标包括镇痛泵按压次数、被动和主动补救镇痛次数,产妇满意度,以及产程时间、器械助产率、新生儿Apgar评分。结果与对照组比较,研究组最高VAS疼痛评分、VAS疼痛评分≥7分的比例明显降低(P<0.05),镇痛泵按压次数、补救镇痛次数明显减少(P<0.05),有效按压次数、主动补救镇痛次数明显增多(P<0.05),产妇满意度明显提高(P<0.05)。两组产程时间、器械助产率、新生儿Apgar评分等差异均无统计学意义。结论分娩镇痛信息化管理系统的应用有助于减轻产妇的疼痛,增加产妇的满意度,提高分娩镇痛的质量。Objective To observe the clinical effectiveness of the labor analgesia information management system in obstetrics,and make a comparative analysis with pre-application.Methods A total of 425 primiparas with singleton,cephalic presentation,gestational age 37-40 weeks,BMI 22-28 kg/m^2,ASA physical statusⅡ,who reguired labor analgesia were included in this study.The women who delivered from January to June 2018 were divided into the control group(n=213),after the construction of the information-based labor analgesia management system in September 2018,the women who gave birth in January to June 2019 were the study group(n=212).Epidural analgesia was performed by 0.075%ropivacaine and 0.5μg/ml sufentanil administered through an epidural catheter with a model of programmed intermittent epidural bolus(PIEB)plus patient-controlld epidural analgesia(PCEA).Parturient in the study group gave feedback through the iPainfree TM analgesic management system.For parturient having VAS≥4 scores or PCEA≥2 times within half an hour,the anesthesiologist would remedy the pain.The primary outcomes were the highest VAS scores during labor and the proportion of parturient with VAS≥7 scores.The secondary outcomes were the number of times the analgesia pump,the number of times for rescue analgesia,the satisfaction of primiparas,the time of labor,the method of delivery,and the Apgar scores.Results Compared with the control group,the proportion of the highest VAS and VAS≥7 scores,the numbers of PCEA and passive remedial analgesia were lower,the numbers of PCEA and active remedial analgesia were higher,and maternal satisfaction was significantly improved in the study group(P<0.05).There were no significant differences in stage of labor,delivery mode and Apgar scores of the newborn between the two groups.Conclusion The application of information labor analgesia management system helps reduce maternal pain,increase maternal satisfaction,and improve the quality of labor analgesia.

关 键 词：信息化管理系统 分娩镇痛 程控脉冲给药 

分 类 号：R714.3[医药卫生—妇产科学]