- 學位論文
減痛分娩幫浦模式於臨床人員工作量及麻醉藥物使用量及產婦滿意度之探討
Investigations of different painless program modes on clinicians’ workload, anesthetics consumption and maternal satisfaction
摘要
哺乳類動物生產時均伴隨著中至強度的疼痛，人類為更高等的哺乳類動物，生產時的疼痛除引起當下不舒服的感受外，還可能引發後續生理、心理、社會行為反應，但許多後續會有多大或多深遠影響仍不清楚。臨床上，能提供生產時的止痛方式有許多選擇，其中公認最有效的方式為硬膜外止痛法，麻醉醫師在下腰椎第二至五節間置放導管，給予sodium channel阻斷型的局部麻醉劑達到止痛的效果，現今藥物的給予多已由幫浦給予，取代人工給予方式。然而不同的幫浦模式對臨床工作量、麻醉藥物使用量、產婦滿意度仍存在許多爭議。因此研究分成四個方向進行探討，包含(1)自然產本身對後續心理健康的衝擊;(2)兩種最常用的減痛分娩專用幫浦模式(CEI vs. PIEB)對於產婦滿意度及副作用的差異;(3)兩種幫浦模式麻醉藥物的消耗量的探討;(4)兩種幫浦模式造成臨床作量是否不同的探討。研究結果顯示:自然產對於心理衝擊為罹患產後憂鬱比例26.66%，需使用安眠藥物或抗憂鬱藥物治療21.70%，心理衝擊的比例雖高但相對於剖腹生產的產婦而言仍低許多。最常用的兩種幫浦模式間，產婦的滿意度相當均為3.9分/5分，而搔癢、頭暈、噁心、嘔吐、嗜睡等副作用發生率並無明顯差異。兩種模式造成臨床人員工作量方面，PIEB幫浦模式則明顯高於CEI幫浦模式，包含額外訪視次數(1.60次 vs. 0.86次)、額外訪視比率(63.7% vs. 47.2%)、設定參數更改比率(52.6% vs. 33.6%)。兩種模式在麻醉藥物消耗量則是CEI幫浦模式明顯高於PIEB幫浦模式，包含了藥物總消耗量、平均每小時消耗量，並且發現平均每小時消耗量呈現了隨時間遞減的效應。 關鍵字: 減痛分娩、幫浦模式、臨床工作量、麻醉藥物消耗量
並列摘要
Mammalian childbirth is invariably accompanied by moderate to severe pain. For humans, as higher-order mammals, the pain experienced during childbirth not only causes immediate discomfort but can also lead to subsequent physiological, psychological, and social behavioral responses, the extent and depth of which remain unclear. Clinically, epidural analgesia is considered the most effective pain relief method. It involves placing a catheter between the second and fifth lumbar vertebrae to administer local anesthetics, usually via a pump. However, the clinical workload, anesthetic usage, and maternal satisfaction associated with different pump modes remain debated. This study examines four aspects: (1) the impact of natural childbirth on subsequent mental health; (2) differences in maternal satisfaction and side effects between the two most commonly used analgesic delivery pump models (CEI vs. PIEB); (3) investigation into the consumption of anesthesia drugs between the two pump models; and (4) examination of differences in clinical workload between the two models. Results show that natural childbirth has a significant psychological impact, with 26.66% experiencing postpartum depression and 21.70% requiring medication. This impact is lower compared to cesarean sections. Both pump modes yielded similar maternal satisfaction scores of 3.9 out of 5, with no significant differences in side effects like itching, dizziness, nausea, vomiting, or drowsiness. However, the PIEB mode resulted in a higher clinical workload, including more frequent additional visits (1.60 vs. 0.86 times), higher additional visit rates (63.7% vs. 47.2%), and higher parameter adjustment rates (52.6% vs. 33.6%). The CEI mode had a higher total and average hourly anesthetic consumption, which decreased over time. Keywords: painless labour, pump models, clinical workload, anesthesia drug consumption