非药物性分娩镇痛在阴道试产产妇产程管理中的证据总结

doi:10.3761/j.issn.0254-1769.2021.07.022

摘要/Abstract

摘要：

目的检索、评价和总结非药物性分娩镇痛在阴道试产产妇产程管理中的证据。方法系统检索英国国家临床优化研究所网站、美国妇产科医师学会网站、加拿大妇产科医师学会网站、国际指南协作网、乔安娜布里格斯研究所循证卫生保健图书馆、UpToDate、Cochrane图书馆、中国知网、万方、Pubmed等国内外数据库和网站关于非药物性分娩镇痛在阴道试产产妇产程管理的证据,包括临床决策、指南、系统评价、专家共识等。检索时限为2014年1月—2019年9月。由2名研究员独立进行文献评价,对符合标准的文献进行资料提取。结果共纳入12篇文献,包括1篇指南、2篇临床决策、5篇系统评价、4篇证据总结,包括非药物分娩镇痛的疼痛评估与实施时机、支持性环境、陪伴分娩、冷热敷、呼吸与放松技术、经皮神经电刺激疗法、水中待产、抚触按摩、活动与体位9个方面,共33条证据。结论该研究总结了非药物性分娩镇痛在阴道试产产妇产程管理中的证据,可为助产机构实施非药物性分娩镇痛的规范化管理提供依据。

关键词: 非药物性分娩镇痛, 产程管理, 围产期, 循证护理, 证据总结

Abstract:

Objective To retrieve the best evidence of management of non-pharmacological labor analgesia for women with trial of labor. Methods We systematically searched National Institute for Health and Clinical Excellence（NICE）,American College of Obstetricians and Gynecologists（ACOG）,the Society of Obstetricians and Gynecologists of Canada（SOGC）,Guidelines International Network（GIN）,Joanna Briggs Institute（JBI）,Uptodate,Cochrane Library,CNKI,Wanfang Database,Pubmed to collect guidelines,best practices,expert consensuses. The retrieval period was from January 2014 to September 2019. 2 researchers with evidence-based nursing background assessed the quality of the literature independently and extracted the evidence. Result A total of 12 articles were included,including 1 clinical guideline,2 clinical decisions,5 systematic reviews and 4 evidence summaries. 33 pieces of evidence were obtained,including the implementation timing,supportive environment,accompany delivery,cold and hot compress,breathing and relaxation techniques,transcutaneous electrical nerve stimulation,water labor,touching and massage,posture and activity. Conclusion This study summarized the best evidence of management of non-pharmacological labor analgesia for women with trial of labor,which can provide evidence-based practice bases for standardized management of non-pharmacological labor analgesia in maternity settings.

Key words: Non-Pharmacological Labor Analgesia, Labor Management, Perinatal Period, Evidence-Based Nursing, Evidence Summary

王晓娇,顾春怡,张铮,闵辉,郭琳. 非药物性分娩镇痛在阴道试产产妇产程管理中的证据总结[J]. 中华护理杂志, 2021, 56(7): 1086-1092.

WANG Xiaojiao,GU Chunyi,ZHANG Zheng,MIN Hui,GUO Lin. Evidence summary of management of non-pharmacological labor analgesia for women with trial of labor[J]. Chinese Journal of Nursing, 2021, 56(7): 1086-1092.

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参考文献 38

[1]	Czech I, Fuchs P, Fuchs A, et al. Pharmacological and non-pharmacological methods of labour pain relief—establishment of effectiveness and comparison[J]. Int J Environ Res Public Heal, 2018, 15(12):2792.
[2]	Junge C, von Soest T, Weidner K, et al. Labor pain in women with and without severe fear of childbirth:a population-based,longitudinal study[J]. Birth, 2018, 45(4):469-477. DOI URL
[3]	Serçekuş P, Okumuş H. Fears associated with childbirth among nulliparous women in Turkey[J]. Midwifery, 2009, 25(2):155-162. PMID
[4]	Fleet JA, Jones M, Belan I. The influence of intrapartum opioid use on breastfeeding experience at 6 weeks post partum:a secondary analysis[J]. Midwifery, 2017, 50:106-109. DOI URL
[5]	Smith CA, Levett KM, Collins CT, et al. Relaxation techniques for pain management in labour[J]. Cochrane Database Syst Rev, 2018, 3:CD009514.
[6]	The AGREE Reporting Checklist：a tool to improve reporting of clinical practice guidelines[J]. BMJ, 2016, 354:i4852.
[7]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research—the quality evaluation of diagnostic and economic eva-luation[J]. J Nurses Train, 2018, 33(8):701-703.
[8]	Smith CA, Levett KM, Collins CT, et al. Massage,reflexology and other manual methods for pain management in labour[J]. Cochrane Database Syst Rev, 2018, 3:CD009290.
[9]	Cluett ER, Burns E, Cuthbert A. Immersion in water during labour and birth[J]. Cochrane Database Syst Rev, 2018, 5:CD000111.
[10]	Hodnett ED, Downe S, Walsh D, et al. Alternative versus conventional institutional settings for birth[J]. Cochrane Database Syst Rev, 2010(9):CD000012.
[11]	Makvandi S, Latifnejad Roudsari R, Sadeghi R, et al. Effect of birth ball on labor pain relief:a systematic review and meta-analysis[J]. J Obstet Gynaecol Res, 2015, 41(11):1679-1686. DOI URL
[12]	Luo TZ, Huang ML, Xia HA, et al. Aromatherapy for laboring women:a meta-analysis of randomized controlled trials[J]. Open J Nurs, 2014, 4(3):163-168.
[13]	Chao AS, Chao A, Wang TH, et al. Pain relief by applying transcutaneous electrical nerve stimulation(TENS) on acu-puncture points during the first stage of labor:a randomized double-blind placebo-controlled trial[J]. PAIN, 2007, 127(3):214-220. DOI URL
[14]	National Institute For Health and Care Excellence. Intrapar-tum care for healthy women and babies ( 2017- 02- 21)[2020- 08- 06]. https://www.nice.org.uk/guidance/cg190
[15]	Madden K, Middleton P, Cyna AM, et al. Hypnosis for pain management during labour and childbirth[J]. Cochrane Data-base Syst Rev, 2016(5):CD009356.
[16]	Meghan AB, Blair OB, Heather MK. Perceptions. Perceptions and experiences of labour companionship：a qualitative evidence synjournal[J]. Cochrane Database Syst Rev, 2019, 3:CD012449.
[17]	Stuebe A, Barbieri RL. Contributor disclosures[EB/OL]. ( 2019- 01- 07)[2020- 08- 06]. http://211.147.88.113/contents/zh-Hans/continuous-labor-support-by-a-doula?search=%E5%88%86%E5%A8%A9%E9%95%87%E7%97%9B&source=search_result&selectedTitle=20%7E46
[18]	Simkin P, Klein MC. Nonpharmacologic approaches to manage-ment of labor pain[EB/OL]. ( 2019- 02- 05)[2020- 08- 06]. https:// www.uptodate.cn/contents/nonpharmacologic-approaches-to-management-of-labor-pain?search=%E9%9D%9E%E8%8D%AF%E7%89%A9%E6%80%A7%E5%88%86%E5%A8%A9%E9%95%87%E7%97%9B&source=Out%20of%20date%20-%20zh-Hans&selectedTitle=6~150
[19]	The Joanna Briggs Institute（JBI） Labor：non pharmacological pain relief[EB/OL]. ( 2017- 03- 26)[2021- 01- 12]. http://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=ONCAFPPJCDEBCAJCIPAKPHEHLFCLAA00&Link+Set=S.sh.52%7c1%7csl_190
[20]	The Joanna Briggs Institute（JBI） Labor：transcutaneous electrical nerve stimulation（TENS） for pain relief[EB/OL]. ( 2017- 05- 19)[2021- 01- 12]. http://ovidsp.dc2.ovid.com/ovid-b/ovi-dweb.cgi?&S=ONCAFPPJCDEBCAJCIPAKPHEHLFCLAA00&-Link+Set=S.sh.63%7c1%7csl_190
[21]	The Joanna Briggs Institute（JBI） Pregnancy,labor and birth：water immersion[EB/OL]. （ 2018- 11- 13）[2021- 01- 12]. http://ovi-dsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=EPNMFPOJCPEBCAI-FJPAKKGBHLMFGAA00&Link+Set=S.sh.21%7c1%7csl_190 http://ovi-dsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=EPNMFPOJCPEBCAI-FJPAKKGBHLMFGAA00&Link+Set=S.sh.21%7c1%7csl_190.
[22]	The Joanna Briggs Institute（JBI） Sterile water injections du-ring labor：effect on women’s outcomes[EB/OL]. （ 2018- 11- 12）[2021- 01- 12]. http://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=EPNMFPOJCPEBCAIFJPAKKGBHLMFGAA00&Link+Set=S.sh.41%7c1%7csl_190 http://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=EPNMFPOJCPEBCAIFJPAKKGBHLMFGAA00&Link+Set=S.sh.41%7c1%7csl_190.
[23]	Hodnett ED, Downe S, Walsh D, et al. Alternative versus conventional institutional settings for birth[J]. Cochrane Database Syst Rev, 2010(9):CD000012.
[24]	翟巾帼, 郑艳芳, 蔡文智, 等. 孕产妇对助产士门诊服务需求的调查分析[J]. 中华护理杂志, 2016, 51(1):45-48.
	Zhai JG, Zheng YF, Cai WZ, et al. A survey of maternal needs toward midwife outpatient services[J]. Chin J Nurs, 2016, 51(1):45-48.
[25]	Hodnett ED, Gates S, Hofmeyr GJ, et al. Continuous support for women during childbirth[J]. Cochrane Database Syst Rev, 2012, 10:CD003766.
[26]	Kozhimannil KB, Henning-Smith C, Hung P. The practice of midwifery in rural US hospitals[J]. J Midwifery Womens Health, 2016, 61(4):411-418. DOI URL
[27]	张羽, 刘艳凤, 彭政, 等. 导乐陪伴分娩对降低剖宫产率及其他分娩结局的影响[J]. 中国生育健康杂志, 2020, 31(1):10-14.
	Zhang Y, Liu YF, Peng Z, et al. The effect of doula continuous care on decreasing caesarean rate and other pregnancy outcomes[J]. Chin J Reproductive Heal, 2020, 31(1):10-14.
[28]	Declercq ER, Sakala C, Corry MP, et al. Listening to mothers III：pregnancy and birth,childbirth connection[J]. ( 2013- 06- 17)[2020- 08- 16]. http://transform.childbirthconnection.org/wpcontent/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf
[29]	申家美. 三线放松法对初产妇产前分娩恐惧和妊娠结局的影响[J]. 中国实用护理杂志, 2020, 36(10):741-746.
	Shen JM. Intervention effect of three-line relaxation method on the fear of childbirth and pregnancy outcome in primipara[J]. Chin J Prac Nurs, 2020, 36(10):741-746.
[30]	黄灵燕, 沈萍华. 全产程多模式分娩镇痛对母婴安全的影响[J]. 中国妇幼保健, 2019, 34(22):5134-5137.
	Huang LY, Shen PH. The effect of multimodal analgesia in total stage of labor on maternal and infant safety[J]. Matern Child Heal Care China, 2019, 34(22):5134-5137.
[31]	张薇, 汪小华. 水中镇痛对初产妇分娩镇痛效果的影响[J]. 中国实用护理杂志, 2016, 32(20):1553-1557.
	Zhang W, Wang XH. Impact of water analgesia on the pain relief for primiparas in labor[J]. Chin J Prac Nurs, 2016, 32(20):1553-1557.
[32]	The American College of Obstetricians and Gynecologists 水中镇痛对初产妇分娩镇痛效果的影响[EB/OL]. ( 2016- 11- 01)[2020- 08- 16]. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/ 11/immersion-in-water-during-labor-and-delivery
[33]	Committee on Obstetric Practice, American Academy of Pediatrics. ACOG Committee Opinion no. 594:immersion in water during labor and delivery[J]. Obstet Gynecol, 2014, 123(4):912-915. DOI URL
[34]	American College of Nurse-Midwives. Hydrotherapy during labor and birth. ( 2014- 04- 01)[2020- 08- 06]. https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000-000286/Hydrotherapy-During-Labor-and-Birth-April-2014.pdf
[35]	颜凤, 林艳, 张慧珠. 孕晚期及产时应用生育舞蹈对产妇分娩结局的影响研究[J]. 中华护理杂志, 2018, 53(9):1035-1038.
	Yan F, Lin Y, Zhang HZ. Effects of dancing for birth during the third trimester and labor on birth outcomes[J]. Chin J Nurs, 2018, 53(9):1035-1038.
[36]	Abdolahian S, Ghavi F, Abdollahifard S, et al. Effect of dance labor on the management of active phase labor pain & clients’ satisfaction:a randomized controlled trial study[J]. Glob J Health Sci, 2014, 6(3):219-226. DOI PMID
[37]	窦姗姗, 白桦, 顾晓乐, 等. 河南省助产工作现状及助产适宜技术应用情况的调查研究[J]. 中华护理杂志, 2018, 53(2):158-161.
	Dou SS, Bai H, Gu XL, et al. Investigation of the present situation of midwifery and the appropriate technical application in Henan Province[J]. Chin J Nurs, 2018, 53(2):158-161.
[38]	黄川雅, 姜梅, 徐鑫芬, 等. 导乐陪伴分娩开展现状的调查[J]. 中华护理杂志, 2019, 54(11):1673-1676.
	Huang CY, Jiang M, Xu XF, et al. Investigation on the status of Doula delivery[J]. Chin J Nurs, 2019, 54(11):1673-1676.