麻醉科医师分娩镇痛实践情况的调查

目的在麻醉科医师中调查分娩镇痛的实践情况。方法采用自制问卷,调查麻醉科医师在分娩镇痛方法、药物选择、给药模式以及分娩镇痛相关问题的看法。借助"中国基层麻醉网"于2019年1月20-27日实施问卷发放与回收。结果 923位麻醉科医师参与此项调查。其中工作年限在10年以上有674位(73.1%),高级职称316位(34.2%),二级医院占比62.2%,三级占比31.1%,公立医院占比84.2%,综合医院占比80.2%。最常用的镇痛方式包括椎管内分娩镇痛(77.4%)和导乐镇痛(41.2%)。椎管内分娩镇痛最常用的局麻药是罗哌卡因(91.9%),局麻辅助药为舒芬太尼(62.3%),最常用的给药模式是产妇自控镇痛(82.5%),其中,有84.4%采用有背景剂量给药模式。分娩镇痛期间常规监测BP、HR和SpO2以及胎心率,但下肢肌力监测率只有33.9%。78.0%的麻醉科医师选择产程启动后产妇第一次要求镇痛时及时实施椎管内分娩镇痛,而不必等待宫口开大4 cm;22.0%的麻醉科医师认为即使产妇要求也必须等待宫口开大4 cm才能实施分娩镇痛。15.6%的麻醉科医师认为椎管内分娩镇痛会增加器械助产率,5.2%认为其会增加剖宫产率。结论椎管内分娩镇痛是最常用的镇痛方法,罗哌卡因复合舒芬太尼是最常用的椎管内分娩镇痛配方。分娩镇痛正确的启动时机还需继续宣传,分娩镇痛期间产力监测的意识还有待加强。

Current status survey on practice of labor analgesia among anesthesiologists

Objective To assess knowledge and practice of labor analgesia among anesthesiologists. Methods The questionnaire was self-designed, with the focus on method selection, drugs and administration model during labor analgesia, and opinion to the labor analgesia. The questionnaire was distributed and recycled through the network about grassroots anesthesia. Results There were 923 responses to the survey. There were 674(73.1%) participants working for more than 10 years, 316(34.2%) as senior professional title, 574(62.2%) in level II hospitals, 287(31.1%) in level III hospitals, 777(84.2%) in public hospitals, and 740(80.2%) in general hospitals. Epidural labor analgesia(77.4%) and Doula Support(41.2%) were the most common methods. Ropivacaine(91.9%) was considered the drug of choice and sufentanyl(62.3%) was the standard adjuvant used. PCEA(82.5%) was the most popular mode. Majority of the respondents considered using noninvasive blood pressure, heart rate, pulse oximetry, and fetal monitoring during conduct of regional analgesic techniques, while only 33.9% of them monitored muscle force of lower limbs. 78.0% of respondents thought the first asking for analgesia after labor process onset as the optimum time for labor analgesia beginning, while 22.0% of them thought labor analgesia should not be set up until 4 cm cervical dilatation. In addition, there were 15.6% of respondents believed intrathecal labor analgesia would increase instrumental delivery, while 5.2% of them believed it would increase the incidence of cesarean section. Conclusion Epidural analgesia is the most common technique practiced, and ropivacaine is the commonly used local anesthetic, while sufentanyl was common adjuvant used in practice of labor analgesia. It is necessary to train more anesthesiologists about the optimum onset time of labor analgesia and muscle force monitoring during labor analgesia.