上海市2018-2020年分娩镇痛调查与分析  

Survey and analysis of labor analgesia in Shanghai from^(2)018 to 2020

作　　者：李胜华[1] 罗威[1] 张丽峰 徐子锋[2] 田红 于布为[4] LI Shenghua;LUO Wei;ZHANG Lifeng;XU Zifeng;TIAN Hong;YU Buwei(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]上海交通大学医学院附属国际和平妇幼保健院麻醉科 [3]上海市医师协会 [4]上海交通大学医学院附属瑞金医院麻醉科

出　　处：《上海医学》2021年第11期841-845,共5页Shanghai Medical Journal

基　　金：上海市嘉定区卫生计生系统新一轮医学重点学科(2017ZD08)。

摘　　要：目的调查上海市开展分娩镇痛工作取得的新成绩和面临的新挑战,为进一步推广和普及分娩镇痛提供数据基础和决策制订依据。方法采用自制问卷,由上海市医师协会麻醉科医师分会和上海市医学会麻醉科专科分会发布通知,对本研究的目的及问卷填写进行说明与解释,借助“问卷星”网站平台(http:∥www.wjx.com)实施问卷发放与回收。结果发放问卷88份,回收问卷55份,55份中有效问卷52份,无效问卷3份。52家医院2018年、2019年分娩量分别占当年上海市分娩总量的86.9%(151501/174250)、89.4%(152845/170926),分娩镇痛率分别为48.1%(40356/83895)、58.2%(49826/85653)。2020年1-7月分娩镇痛率为60.8%(24397/40144),其中10家妇幼专科医院为74.3%(20137/27094)、其他42家医院为32.6%(4260/13050)。近年分娩镇痛率与2017年(37.2%)相比增长明显。目前,上海市缺乏针对分娩镇痛的专项收费标准,50家已开展分娩镇痛的医院中有40家医院(80.0%)参照麻醉项目收费标准;完成问卷的52家医院中47家医院(90.4%)建议设立专项收费标准,42家医院(80.8%)建议由医保支付药费和一定比例的镇痛技术服务费。另有45家医院(90.0%,45/50)由于麻醉科医师人力方面的原因导致产妇镇痛期间的疼痛VAS评分>3分,20家医院(40.0%,20/50)需要临时安排麻醉科医师实施分娩镇痛。结论2020年1-7月上海市分娩镇痛率为60.8%,缺乏收费标准和麻醉科医师人员紧缺,以及产科医护人员的认识不足是制约分娩镇痛普及的关键因素;建议尽快出台分娩镇痛专项收费标准,并完善绩效考核机制以调动医务人员的积极性。Objective To investigate the achievements and challenges of labor analgesia in Shanghai,and to provide data and decision-making basis for further popularization of labor analgesia.Methods A self-developed questionnaire was used in this survey.A notice on the purpose of the study and the way how to fill it up was issued by Shanghai Medical Doctor Association of Anesthesiologists and Shanghai Medical Association of Anesthesiology.The questionnaires were distributed and collected with the help of www.wjx.com website platform.Results A total of 88 questionnaires were sent out and 55 copies(including 52 valid and 3 invalid)were collected.The numbers of deliveries in the 52 hospitals in 2018 and 2019 accounted for 86.9%(151501/174250)and 89.4%(152845/170926)of total deliveries in Shanghai,respectively,and the analgesic rates of delivery were 48.1%(40356/83895)and 58.2%(49826/85653),respectively.The analgesic rate of delivery in the 52 hospitals from January to July 2020 was 60.8%(24397/40144),of which 74.3%(20137/27094)was in 10 maternity and child hospitals and 32.6%(4260/13050)in the other 42 hospitals.There was a significant increase in the analgesic rate of delivery in recent years as compared with that in 2017(37.2%).There was a lack of charging standards for labor analgesia in Shanghai.Forty(80.0%,40/50)hospitals charged according to anesthetic programs,47(90.4%,47/52)hospitals proposed to set up special charges,and 42(80.8%,42/52)hospitals recommend medical insurance to pay drug fees and a certain proportion of analgesic service fees.In addition,Visual analogue score(VAS score)was more than 3 points during analgesia in 45(90.0%,45/50)hospitals due to the manpower of anesthesiologists,and anesthesiologists were temporarily arranged to implement labor analgesia in 20(40.0%,20/50).Conclusion The labor analgesia rate is 60.8%from January to July 2020 in Shanghai.The lack of charging standards and anesthesiologists,as well as insufficient awareness on labor analgesia in obstetric medical staff,are key factors restric

关 键 词：分娩镇痛 问卷调查 上海 

分 类 号：R714.3[医药卫生—妇产科学]