摘要
目的 调查北京市助产机构近三年椎管内分娩镇痛工作的开展情况.方法 采用"问卷星"网络平台于2020年11至12月对北京地区94家助产机构椎管内分娩镇痛工作的开展情况进行调查.结果 本调查共收集到调查问卷94份,北京市各助产机构分娩镇痛率极不均衡,其中81家(86.17％)常规开展椎管内分娩镇痛工作,13家(13.83％)未常规开展椎管内分娩镇痛工作.麻醉科医师不足是医院未常规开展椎管内分娩镇痛工作的最突出原因.2018年、2019年、2020年1月至10月未开展椎管内分娩镇痛工作的医院分别为27家、18家、13家.2018年、2019年、2020年1月至10月,整体椎管内分娩镇痛率分别为28.59％、35.17％、39.96％,综合医院分娩镇痛率分别为12.66％、23.24％、29.79％,妇产专科医院和妇幼保健院(以下简称专科医院)分别为51.01％、58.81％、69.27％.29家有麻醉护士参与辅助实施分娩镇痛工作,69家开展24h分娩镇痛工作.18家以腰硬联合麻醉为主,63家医院以连续硬膜外阻滞为主.实施硬膜外阻滞时52家给予1.0％～1.5％利多卡因试验量,11家医院未给予试验量或直接予泵液.结论 北京市各助产机构分娩镇痛率极不均衡,非公立医院分娩镇痛工作开展比例高于公立医院,专科医院开展比例高于综合医院,试点医院开展比例高于非试点医院,综合医院及个别专科医院仍有较大提升空间.麻醉科医师不足制约分娩镇痛工作开展,分娩镇痛管理仍欠规范,专职麻醉护士参与有助于椎管内分娩镇痛工作的实施与管理.
Abstract
Objective To investigate the implementation of intraspinal labor analgesia in Beijing midwifery institutions in the past three years.Methods A survey concerning the implementation of intraspinal labor analgesia was conducted from November to December 2020 in 94 midwifery institutions in Beijing using the"Questionnaire Star"online platform.Results A total of 94 ques-tionnaires were collected in this survey.The rate of labor analgesia was extremely uneven among midwifery institutions in Beijing,with 81(86.17％)routinely carrying out intraspinal labor analgesia and 13(13.83％)not routinely carrying out intraspinal labor analgesia.Shortage of anesthesiologists(69.23％)was the most prominent reason for hospitals not routinely performing intraspinal labor analgesia.The number of hospitals that did not carry out intraspinal labor analgesia in 2018,2019,and January to October 2020 were 27,18,and 13,respectively.In 2018,2019,and January to October 2020,the overall intraspinal labor analgesia rate was 28.59％,35.17％and 39.96％,respectively.The rate of labor analgesia in general hospitals was 12.66％,23.24％and 29.79％,respectively,and was 51.01％,58.81％and 69.27％in maternity hospitals and maternal and child healthcare hospitals(hereinafter referred to as specialist hospitals),respectively.In 29 hospitals,nurse anesthetists were involved in labor analgesia,and in 69 hospitals,24-hour labor analgesia was pro-vided;in 18 hospitals,combined spinal-epidural anesthesia was the mainstay,and in 63 hospitals,continuous epidural block was the mainstay.In 52 hospitals,1.0％-1.5％lidocaine was given as a test dose during epidural block,and in 11 hospitals,no test dose was given or pumping fluid was given directly.Conclusions The rate of labor analgesia is very uneven among midwifery institutions in Beijing.The proportion of labor analgesia in non-public hospitals is higher than that in public hospitals;the proportion in specialized hospitals is higher than that in general hospitals;and the proportion in pilot hospitals is higher than that in non-pilot hospitals.General hospitals and some specialized hospitals still have much room for improvement.The lack of anesthesiologists restricts the implementa-tion of labor analgesia in childbirth,and the management of labor analgesia is still not standardized;the participation of full-time nurse anesthetists is helpful in the implementation and management of intraspinal labor analgesia.
基金项目
北京市卫健委卫生与健康科技成果和适宜技术项目(BHTPP2022022)
首都医科大学医院管理研究所2021年度开放性课题(2021YGS06)
NETL
NSTL
万方数据