笑气吸入在分娩镇痛中的应用

目的探讨笑气吸入在分娩镇痛中的效果和对母儿的影响.方法对136例产妇在产程中给予吸入50%氧化亚氮(笑气)和50%氧气组成的混合气体实行镇痛分娩(研究组),另选择200例产妇在产程中不给予笑气吸入(对照组),观察两组产妇疼痛的程度、产程时间、分娩方式、羊水情况、产后出血量和新生儿Apgar评分等.结果研究组的镇痛有效率和自然分娩率高于对照组;总产程时间短于对照组,两组比较差异有显著性(P＜0.05).羊水污染、新生儿窒息率和产后出血,两组比较差异无显著性(P＞0.05).结论吸入50%氧化亚氮(笑气)和50%氧气组成的混合气体用于分娩镇痛可有效地缓解分娩疼痛,缩短产程时间,对母儿无不良影响,是一种安全、有效、简便的镇痛方法.     

Consensus Statement No. 434: Simulation in Obstetrics and Gynaecology

ObjectiveTo provide a comprehensive and current overview of the evidence for the value of simulation for education, team training, patient safety, and quality improvement in obstetrics and gynaecology, to familiarize readers with principles to consider in developing a simulation program, and to provide tools and references for simulation advocates.Target populationProviders working to improve health care for Canadian women and their families; patients and their families.OutcomesSimulation has been validated in the literature as contributing to positive outcomes in achieving learning objectives, maintaining individual and team competence, and enhancing patient safety. Simulation is a well-developed modality with established principles to maximize its utility and create a safe environment for simulation participants. Simulation is most effective when it involves interprofessional collaboration, institutional support, and regular repetition.Benefits, Harms, and CostsThis modality improves teamwork skills, patient outcomes, and health care spending. Upholding prescribed principles of psychological safety when implementing a simulation program minimizes harm to participants. However, simulation can be an expensive tool requiring human resources, equipment, and time.EvidenceArticles published between 2003 and 2022 were retrieved through searches of Medline and PubMed using the keywords “simulation” and “simulator.” The search was limited to articles published in English and French. The articles were reviewed for their quality, relevance, and value by the SOGC Simulation Working Group. Expert opinion from relevant seminal books was also considered.Validation MethodsThe authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).Intended AudienceAll health care professionals working to improve Canadian women’s health, and relevant stakeholders, including granting agencies, physician/nursing/midwifery colleges, accreditation bodies, academic centres, hospitals, and training programs.Recommendations

• 1.Health care professionals in obstetrics and gynaecology should understand the value of both in situ and off-site simulation as a tool for education, patient safety, and quality improvement at both the team and individual levels (strong, moderate).
• 2.Health care professionals in obstetrics and gynaecology should be aware of the overall cost reduction associated with the use of simulation (strong, moderate).
• 3.Stakeholders at all levels must commit to an ongoing simulation program, including identifying, training, and supporting simulation advocates, as well as securing adequate funding. This approach leads not only to organizational readiness but also to quality improvement and positive culture change (strong, moderate).
• 4.Providers of obstetrical and gynaecological care should be familiar with key simulation modalities and principles of how to advance knowledge using simulation (conditional, low).
• 5.Purposeful simulation activities must be based on local needs assessments and knowledge gaps (conditional, low).
• 6.Interprofessional/interdisciplinary teams should participate in the design, implementation, and evaluation of team training and in situ simulation programs (strong, high).
• 7.Debriefing must be promoted as a fundamental component of the experiential learning process. Team debriefing/peer debriefing with a written guide can be as effective (as an alternative) as expert debriefing (strong, high).
• 8.Psychological safety must be established for all personnel within the simulation and the debriefing (strong, moderate).
• 9.Program evaluation, a system to measure the efficacy of a learning activity, must be included in the planning of simulation activities to assess whether the targeted outcomes of the program were achieved (strong, moderate).
• 10.Simulation-based activities should be designed in a culturally sensitive and socially responsible way, similar to all other aspects of health professionals’ education (strong, low).