文献导读||影响无痛分娩实施的因素

本文由“小麻哥的日常"授权转载

摘要译文

分娩期间无疼痛管理：个人和组织决定因素：2016年法国全国围产期调查的二次分析

背景：

在一些医疗机构，如急诊科和重症监护室，已发现疼痛管理方面存在差异，但在分娩镇痛方面，仍缺乏探索。

目的：

确定分娩期间无疼痛管理的妇女比例及其个人和机构决定因素。

设计：

对2016年法国全国围产期调查这项全国性横断面人群研究进行二次分析。

机构：

法国所有产科病房。

参与者：

10011名尝试阴道分娩且产程至少15分钟的女性。

主要观察指标：

没有疼痛管理，定义为分娩期间没有采取任何药理学或非药理学镇痛方法。

结果：

在10 011名女性中，542名（5.4%）没有进行过分娩疼痛管理：8526名女性中有318名（3.7%）最初倾向于使用神经轴镇痛，1402名女性中有222名（15.8%）没有。使用根据产妇产前神经轴镇痛偏好分层的广义估计方程，两组无分娩疼痛管理的共同决定因素是没有参加分娩教育课程和夜间进入分娩机构。在最初倾向于使用神经轴镇痛的女性中，与年分娩2000至3499人次的机构相比，在年分娩次数少于1500人次的机构中分娩的女性更有可能不进行疼痛管理[调整后的优势比（OR）=1.96；95%可信区间（CI），1.39至2.78]；在那些不喜欢使用它的人中，出生在国外的女性更有可能不进行分娩疼痛管理（调整后OR=1.64；95%CI，1.12至2.40）。

结论：

在法国，1:20的女性没有进行分娩疼痛管理，而在不使用神经轴镇痛的女性中，这一比例高出三倍。加强产妇关于分娩疼痛及其管理方面的信息，特别是非药物方法，并重新考虑医疗机构，可以提高任何形式的镇痛比例。

原文摘要

Nopain management for labour: individual and organisational determinants: Asecondary analysis of the 2016 French National Perinatal Survey

Background: 

Disparities in access to pain management have been identified inseveral care settings, such as emergency departments and intensive care units,but with regard to labour analgesia, it remains poorly explored.

Objectives: 

To determine the proportion of women without pain managementduring labour and its individual and organisational determinants.

Design:

Secondary analysis of a nationwide cross-sectionalpopulation-based study, the 2016 French National Perinatal Survey.

Settings: 

All maternity units in France.

Participants: 

Ten thousand and eleven women who attempted vaginal deliverywith a labour duration at least 15 min.

Main outcome measure: 

Absence of pain management, defined as absence of anypharmacological or nonpharmacological analgesic method during labour.

Results: 

Among the 10 011 women included, 542 (5.4%) had no labour painmanagement: 318 (3.7%) of the 8526 women who initially preferred to useneuraxial analgesia and 222 (15.8%) of the 1402 who did not. Using generalisedestimating equations stratified according to the maternal antenatal preferencefor neuraxial analgesia, the common determinants of no labour pain managementin both groups were no attendance at childbirth education classes and admissionto a delivery unit during the night. Among women who initially preferred to useneuraxial analgesia, those who delivered in units with <1500 annualdeliveries compared with units with 2000 to 3499 annual deliveries, were morelikely to do without pain management [adjusted odds ratio (OR) = 1.96; 95%confidence interval (CI), 1.39 to 2.78]; among those who did not prefer to useit, women born abroad were more likely to do without labour pain management(adjusted OR = 1.64; 95% CI, 1.12 to 2.40).

Conclusion: 

In France, 1 : 20 women had no labour pain management, and thisproportion was three times higher among women who preferred not to useneuraxial analgesia. Enhancing maternal information on labour pain and itsmanagement, especially nonpharmacological methods, and rethinking careorganisation, could improve access to analgesia of any kind.