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无痛分娩的是与非

发布日期:2019-11-25

最近,我们接到许多读者打来电话咨询我们医院能不能进行“无痛分娩”。我们专程请到了产科副主任、主任医师王文学教授,请她来回答大家的问题。


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本报记者:王主任好!首先请您为大家讲一下什么是“无痛分娩”吧。

王文学:无痛分娩在医学上称为分娩镇痛,它是使产妇在分娩的过程中减少疼痛的多种方法的统称。分娩镇痛最重要的意义在于有效减少分娩时的疼痛给母婴造成的不良影响,并在一定程度上提高产妇的自然分娩率,使镇痛更人性化。分娩镇痛的方法很多,各种镇痛方法的镇痛效果也不同,多数研究者将分娩镇痛方法分为两大类,即非药物性分娩镇痛方法和药物性分娩镇痛方法。

本报记者:我们医院采用的是哪种分娩镇痛方法呢?

王文学:我们采用的是椎管内阻滞分娩镇痛。椎管内阻滞时产妇交感神经活动被阻断可以达到良好的镇痛效果,子宫灌注良好,胎盘的物质交换得以维持,胎儿的酸碱平衡状态得以改善,产妇的满意度较高。

临床上使用的是病人自控硬膜外(PCEA)技术,PCEA 技术是通过应用一种特殊的微量泵,由麻醉医师设置适当的参数,根据产妇自身的需求设置单次给药量以及持续背景输注量等指标,个体化用药,解决了不同患者不同疼痛程度下对镇痛药物的需求,是目前比较常用的分娩镇痛方法。

本报记者:有产妇咨询称打了“无痛分娩”后还是会痛,有时候还会痛得很厉害,这是为什么呢?

王文学:打了“无痛分娩”以后依然还会痛的主要原因有以下两点:一是产程早期镇痛不做(到了宫口开3公分才开始做),太晚了不做,第二产程停用,甚至拔管。目前中国大多数医院在临产以后并不会直接给你打“无痛分娩”,哪怕你痛得要死要活,一般在宫口开大到3公分以后才会给你打“无痛分娩”。但是,从正式临产到宫口开大3公分的时间会比较长,平均大约需要6-8个小时,所以即使是后来你打了“无痛分娩”,但是你的整个分娩过程还是经历了很长时间的疼痛。事实上,我们完全可以安全地采用“全产程分娩镇痛”,也就是说只要你临产了,只要你感觉到痛了,就可以打“无痛分娩”,只是不同的产妇在药物配方上有些区别,而且宫口开全以后的第二产程根本没有必要去停药甚至拔管。无论是单纯硬膜外还是腰硬联合镇痛,用于全程镇痛都没有问题。二是技术问题导致的“镇痛不全”。打了“无痛分娩”还继续痛的问题被称为“镇痛不全”,“镇痛不全率”是指实施了分娩镇痛后有望达到无痛分娩人群中,最终达不到满意效果的人数之比,它所反映的是镇痛质量的好坏问题。根据不同国家和不同医院的报道,镇痛不全率大约在5-10%左右,大家可以清晰地看到,镇痛不全并不是一个罕见现象,而是一个值得重视的临床问题。

本报记者:无痛分娩适用于所有产妇吗?

王文学:当然不是,部分产妇因为一些高危妊娠的“禁忌证”而无法享受 “无痛分娩”。“高危”产妇是指有各种内外科合并症,例如心脏病、高血压、肝肾功能异常、神经系统疾患等。其实,符合椎管内分娩镇痛禁忌证的孕妇数量并不多:一是产妇拒绝接受。相信随着大家对无痛分娩的认识,这个禁忌证很快就会消失;二是不能放置硬膜外导管的产妇。比如做过某些(并不是所有)腰椎手术的产妇;再有就是对产妇可能造成危害的医疗情况,例如有血小板和凝血机制障碍和有局部感染的产妇。

本报记者:除了您所说的“椎管内镇痛”法,还有其他镇痛方式吗?

王文学:虽然“无痛分娩”有很多的好处,但还是会有产妇选择“无痛分娩”以外的其他镇痛方式,这是理念的不同所造成的。例如,有产妇选择“可行走的硬膜外”,也就是说选择不同的药物配方和比较小的药物剂量,产妇可以在家人或者是医务人员的陪同下四处走动,这种方法有镇痛效果但还是会感受一定程度的疼痛。还有水中待产、水中分娩以及其他的非药物性镇痛方式。这其实是对临床目标追求的不同所导致的选择方式不同。认知不同,理念不同,就会有不同的行为和不同的选择。作为医生,我们应该提供所有的选择可能,在充分告知的前提下,尊重、支持和配合产妇的选择,让她开心,让她满意,让她安全。


Tianjin Baodi hospital was founded in May 1949, it is among the best ranking hospitals, which integrates medical treatment, teaching, scientific research, prevention, health care and rehabilitation. It is the supporting unit of National Natural Science Foundation Committee, the national general practitioner standardized training base and one of the first group of standardized resident training base in China.In February 2024, it became Baodi Hospital affiliated to Tianjin Medical University.

The hospital covers an area of 60,000 square meters, with a building area of 72,000 square meters and 735 beds. The approved area covers 218.7 mu, with a construction area of 305,000 square meters, and 1,400 beds. The hospital now has 1223 employees, including 1139health professionals, 225senior professionals, 11 doctoral students and 240master students. There are 2 persons enjoying special allowance of the State Council and 1 Ph.D supervisor and 19 master supervisor. The hospital has more than 72 specialized departments, and the department of ophthalmology, neurology, cardiology, obstetrics and gynecology, oncology, pediatrics, nephrology, orthopedics and anesthesiology are listed as key disciplines at district level. In 2023, it recorded 1.28 million annual consultations, 47,400 discharged patients and 28,600 in-patient surgeries. Our doctors performed Interventional diagnosis and treatment of cerebrovascular diseases, multidisciplinary comprehensive treatment of malignant tumors, rescue of severe trauma patients, comprehensive treatment of difficult and critically ill patients, diagnosis and treatment of critically ill neonates, complex major surgical operations and orthopedic multi-site replacement and other bone disease treatments. Minimally invasive operations such as 3D laparoscopy, thoracoscopy, and resection of prostate have reached the city's advanced level. Our hospital actively promotes green channels for acute myocardial infarction, stroke, critically ill pregnant women, trauma, etc with standardized approach throughout. The "National Chest Pain Center", "National Stroke Prevention Center" and "Painless Childbirth Pilot Hospital" were listed successively, and were designated as "Critical Maternal Rescue Center" and "Newborn Rescue Center" by the Municipal Health Commission.

The hospital has complete facilities, well-developed functions and advanced equipment., such as digitalized outpatient and emergency rooms and inpatient wards. The hospital is equipped with PET-CT, linear accelerator, energy spectrum CT, 3.0T nuclear magnetic resonance, two-way digital flat-panel angiography system, dual-source lithotripsy holmium laser lithotripsy system, four-dimensional color Doppler ultrasound, 3D laparoscopy, thoracoscopy, intervertebral foraminoscope and the like, artificial The heart-lung machine and the fully automatic orthopedic operating table to provide hardware guarantee for the development of new technologies and new projects in the hospital.

The hospital adheres to the hospital spirit of "honesty, dedication, benevolence and devotion", and implements the "patient-centered" service concept in all aspects of medical services and every aspect of the hospital's work, continuously improving medical quality, standardizing medical behavior, and improving Service measures, optimize the medical environment, and strive to provide patients with safe, effective, convenient and economical medical services . There are 25 specialties, 215 disease types carry out clinical pathway management, 125 disease types carry out single disease payment management, and 26 operation types carry out day operation. The whole hospital makes great use of information technology to carry out a variety of appointment services. Focusing on hot issues of public concern such as "one elderly, one child, one emergency, and one complaint", the "Elderly Medical Service Month" and "Smile Service" actions are carried out in depth. A one-stop outpatient service center has been established, and 100% of the 20 wards provide high-quality nursing services. With the continuing effort to establish high standard of professionalism and ethics, the hospital has become among the city's first "Hospital without red envelope". The comprehensive satisfaction of patients reached over 98%, and it continued to rank among the top-tier general hospitals in the city.

The hospital actively assumes social responsibilities and assists and guides the standardized diagnosis and treatment services of the first and second-level hospitals in the area. It has successively selected a number of medical, nursing and management key individuals to participate in aid to Africa,Tibet, Xinjiang and Gansu as well as public health emergencies.

The work of the hospital has been highly appraised and praised by the majority of patients, people from all walks of life, leaders and the health community. The news media of the central government and Tianjin have reported the stories of the hospital on many occasions. Hospital successively won the “National advanced collective of medical and health system”, “National medical and health system to strive for excellence”, “Top 100 hospitals in China”, “Top 100 demonstration hospitals for the people in China”, “National advanced hospital culture construction unit”, “Home of national model workers” and “Tianjin high quality nursing service demonstration hospital”, “Nomination award of the third China Quality Award”. It has been awarded the honorary title of "Good Hospital with the satisfaction of Tianjin People" for six times.

 

 

Tel:022-29241553

Fax:022-29241700

Website:https:// www.bddhospital.com

Address: No.8 Guangchuan Road, Baodi, Tianjin.