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[摘要] 开展分娩镇痛能有效减轻和消除产痛。笔者医院从1989年开始施行椎管内神经阻滞分娩镇痛7 000余例，未发生一例严重并发症，有以下几点管理经验：①高度重视宣教工作，在各新闻媒体、孕妇学校、产科门诊、病房及产房由具有分娩镇痛管理经验的麻醉医师和助产士向孕妇及其家属宣传分娩镇痛，让产妇及其家属理解分娩镇痛，自愿施行分娩镇痛；②建立严格的分娩镇痛管理制度和操作流程，确保母婴安全；③产房配备充足的抢救用品及监护设备；④医院重视和支持，给予政策倾斜和激励，调动了麻醉科和产科开展分娩镇痛的积极性；⑤有良好的团队精神，麻醉科和产科做到团结一致，相互尊重、信任、理解和支持；⑥重视推广科研成果，得到同行和社会对分娩镇痛的肯定。
[关键词] 分娩镇痛；宣教；管理
[] C[文章编号] 1673-7210（2012）08（b）-0157-03
Experience of propaganda, education and management of labor analgesia
ZHOU Chaoming LI Junjun GONG Zukang JIANG Wu LAO Chengyi ZHANG Dihua
Nanning Maternal and Child Health Service Center, Guangxi Zhuang Autonomous Region, Nannin
[Abstract] Labor analgesia can effectively reduce and eliminate the pain of childbirth. Authors' hospital has implemented intraspinal nerve block labor analgesia for more than seven thousand cases since 1989 and there is no case of severe complications reported. Authors thus draw the following several management lessons: ①Attaching great importance to the propaganda and education of labor analgesia by approaching pregnant women and their relatives through various news media, schools, obstetric out-patient ward and delivery room by anesthesiologists and midwives; ②establishment of strict labor analgesia management systems and operational procedures to ensure maternal and infant safety; ③equiping the delivery room with plenty of rescue supplies and monitoring equipment; ④mobilizing the enthusia of anesthesiology and obstetrics departments to perform labor analgesia by hospital attention, supporting and giving policy supporting and encouragement; ⑤hing good teamwork between anesthesiology and obstetrics departments to achieve solidarity, mutual respect, trust, understanding and support; ⑥paying attention to promotion of scientific research and wining recognition of labor analgesia from peer and society.
[Key words] Labor analgesia; Propaganda and education; Management
在医学疼痛指数中，分娩疼痛仅次于烧灼痛而位居第二位。对大多数妇女来说，分娩疼痛是其一生中经历的最剧烈的疼痛。分娩过程中剧烈疼痛引起的焦虑、恐惧等心理反应可造成母体和胎儿内环境的改变，对产妇采用适当的疼痛缓解措施，可以使疼痛及应激反应减弱甚至消失，改善母体和胎儿的氧供需平衡，对母婴有益[3]。分娩过程中良好的镇痛还可减少或消除母体过度通气，对控制产后抑郁症发生也有积极的作用[4]。目前，我国的分娩镇痛率不足1 %，而剖宫产率却高达50%，并还有逐步攀升的趋势。西方发达国家的椎管内阻滞分娩镇痛率高达80%，剖宫产率却在20%以下[5]。因此，在我国剖宫产率居高不下的现状下，开展分娩镇痛对降低剖宫产率有积极作用[6]。随着社会的发展，产妇分娩过程中是否痛苦，反映了一个社会的文明程度，减轻产妇痛苦是每名医护人员的责任，是对生命个体的尊重，是一种生育文明[7]。我院从1989年起开展施行椎管内神经阻滞等方法，已成功分娩镇痛7 000余例，镇痛效果可靠，未发生一例严重并发症。现将几点成功管理经验与同行分享（图1）：
[关键词] 分娩镇痛；宣教；管理
[] C[文章编号] 1673-7210（2012）08（b）-0157-03
Experience of propaganda, education and management of labor analgesia
ZHOU Chaoming LI Junjun GONG Zukang JIANG Wu LAO Chengyi ZHANG Dihua
Nanning Maternal and Child Health Service Center, Guangxi Zhuang Autonomous Region, Nannin
源于：免费毕业论文www.udooo.com
g 530011, China[Abstract] Labor analgesia can effectively reduce and eliminate the pain of childbirth. Authors' hospital has implemented intraspinal nerve block labor analgesia for more than seven thousand cases since 1989 and there is no case of severe complications reported. Authors thus draw the following several management lessons: ①Attaching great importance to the propaganda and education of labor analgesia by approaching pregnant women and their relatives through various news media, schools, obstetric out-patient ward and delivery room by anesthesiologists and midwives; ②establishment of strict labor analgesia management systems and operational procedures to ensure maternal and infant safety; ③equiping the delivery room with plenty of rescue supplies and monitoring equipment; ④mobilizing the enthusia of anesthesiology and obstetrics departments to perform labor analgesia by hospital attention, supporting and giving policy supporting and encouragement; ⑤hing good teamwork between anesthesiology and obstetrics departments to achieve solidarity, mutual respect, trust, understanding and support; ⑥paying attention to promotion of scientific research and wining recognition of labor analgesia from peer and society.
[Key words] Labor analgesia; Propaganda and education; Management
在医学疼痛指数中，分娩疼痛仅次于烧灼痛而位居第二位。对大多数妇女来说，分娩疼痛是其一生中经历的最剧烈的疼痛。分娩过程中剧烈疼痛引起的焦虑、恐惧等心理反应可造成母体和胎儿内环境的改变，对产妇采用适当的疼痛缓解措施，可以使疼痛及应激反应减弱甚至消失，改善母体和胎儿的氧供需平衡，对母婴有益[3]。分娩过程中良好的镇痛还可减少或消除母体过度通气，对控制产后抑郁症发生也有积极的作用[4]。目前，我国的分娩镇痛率不足1 %，而剖宫产率却高达50%，并还有逐步攀升的趋势。西方发达国家的椎管内阻滞分娩镇痛率高达80%，剖宫产率却在20%以下[5]。因此，在我国剖宫产率居高不下的现状下，开展分娩镇痛对降低剖宫产率有积极作用[6]。随着社会的发展，产妇分娩过程中是否痛苦，反映了一个社会的文明程度，减轻产妇痛苦是每名医护人员的责任，是对生命个体的尊重，是一种生育文明[7]。我院从1989年起开展施行椎管内神经阻滞等方法，已成功分娩镇痛7 000余例，镇痛效果可靠，未发生一例严重并发症。现将几点成功管理经验与同行分享（图1）：
1 高度重视宣教工作
分娩镇痛在我国的开展尚处于起步阶段，要使人们认知和接受，必须重视宣教工作。据我院向2 500例孕妇的问卷调查显示，有约80%的孕妇认为生小孩一定会很痛，大多数孕妇认为分娩必痛，对即将面临的分娩都有不同程度的紧张、恐惧心理。因惧怕产痛，孕产妇及家属往往选择剖宫产，不知道分娩镇痛是怎么回事，或者认为分娩镇痛会影响胎儿等。从2005年开始，我院充分利用报纸、网络等新闻媒体宣传分娩镇痛，在医院孕妇学校、产科门诊、病房及产房宣传分娩镇痛，向孕妇及其家属发放宣传资料。医院将孕妇学校设在产科门诊附近，方便孕妇做产前检查时到孕妇学校听课。孕妇学校坚持每周一至周五开课，并坚持每星期安排具有分娩镇痛操作和管理经验的麻醉医师授课，向前来听课的孕妇、孕妇丈夫等亲属讲分娩镇痛的意义、施行分娩镇痛的好处、产痛可能会产生的不利影响、几种常用分娩镇痛（如椎管内神经阻滞、笑气吸入、水中分娩等）的操作方法、镇痛效果、优缺点等，并回答孕妇及其亲属关心的问题。医院将麻醉科电话作为分娩镇痛咨询向社会公布，由麻醉医师负责解答疑问。六年来，到我院孕妇学校听分娩镇痛课的孕妇及其亲属达4 000余例（次）。医院还在产房门口张贴孕妇及其家属最想了解的分娩镇痛问题，内容通俗易懂，在产房的产妇同意施行分娩镇痛后，在门口守候的家属也已详细阅读了分娩镇痛内容，便很容易同意和支持产妇施行分娩镇痛，效果良好。对分娩镇痛犹豫或者产妇和其家属对施行分娩镇痛意见不统一时，暂时不要施行分娩镇痛，等待产妇和其家属完全理解分娩镇痛，自愿施行并在分娩镇痛知情同意书签字后，才为其施行分娩镇痛，避免因为沟通不到位而引起医疗纠纷。源于：大学生论文查重www.udooo.com